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HomeMy WebLinkAboutOpening of Bids - 2024 Sewer and Manhole Rehabilitation Proj No. 122-019 - Visu-SewerCITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Project No. For Bids Due Sewer and Manhole Rehabilitation 122-019 July 9,2024 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statulory requirements. ln preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. /Proper bid security included. The bidder has the option of providing either a Certified Check or Bid Bond. ,/ Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completelyV executed. Contractor's Non-Collusion and Non-Debarment Affidavit, Certification Regarding lnvestments with lran, Employment Eligibility Verification, Non-Discrimination Commitment, and Certification of use of United States Steel Products or Foundry Products./ ,/ ,/ / / Acknowledge Receipt of 1 nOdendum(s) included with the bid. All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper paCI with name either printed or typed underneath signature. This checklist submitted with the Bid. Thie checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Visu-Sewer, LLC Date:Julv 9.2024 By Authorized Representative: Signature: Print Name & Title: Keith M. Alexander PresidenVCEO Version 611112024 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Sewer and Manhole RehabilitationProject Name Project No. For Bids Due 122-019 July 9,2024 PART I Must be completed for all bids. Please type or Ju I 2024 Bidder (Firm):Visu-Sewer W230 N4855 Betker Drive print) LLCDate: Address: CitylStatelZip: Agent of Bidder (if Telephone Number: ( 262 ) 695-2340 N/A Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: Sewer and Manhole Rehabilitation the City of South Bend, lndiana, in accordance with plans and specifications prepared by: VS Enqineerino. lnc. and dated 612024 for the sum of (enter the Total Bid as shown on the Proposal) ($ (Enter sum of Total Base Bid plus Alternates shown on Proposal)(Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. lf alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. lf additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. lf the bid is to be awarded on a unit basis, rhe itemization of rhe units shail be rnu "n*-rl)w ACCEPTANCE The above bid is accepted this day of 20 Subject to the following conditions: BOARD OF PUBLIC WORKS ) Version 611112024 Contractor's Bid for Public Works - 2 1,529,590.50One Million Five Hundred Twenty Nine Thousand Five Hundred Ninety and 50/100 Dollars Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A, Gilot, Member Breana N. Micou, Member Murray L. Miller, Member Attest: Theresa Heffner, Clerk PART II (For projects of $100,000 or more - lC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. See attached 2. Attach a listing of public works projects currently in process of construction by your organization. See attached 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. N/A 4. Attach references from private firms for which you have performed work. See attached SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor, 3. lf you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. See Attached Version 611112024 Contractor's Bid for Public Works - 3 See Attached See Attached See Attached 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? lf not, attach an explanation for the rationale used which would corroborate the prices listed. Yes SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. See Attached Version 611112024 Contractor's Bid for Public Works - 4 WAIA DocumentA3lo" - 2o1o Bid Bond CONTRACTOR: (Name, legal status and address) Visu-Sewer, LLC W230 N4855 Betker Drive Pewaukee, Wl 53072 SURETY: (Name, legal status and principal place ofbusiness) SiriusPoint America lnsurance Company 285 Fulton Street, 47th Floor, Suite 47J NewYork, NY 10007 This document has important legal consequences. Consultation wlth an attomey is encouragod with respec't to its completion or modificauon. Any singular reforcnce to Contraclor, Surety, Owner or other party shall be considered plural where applicable. OWNER: (Name, legal stolus and address) City of South Bend 227 Wesl Jefferson Blvd. South Bend, lN 46601 BOND AMoUNT; Five Percent (5%) of Total Amount Bid PROJEGT: (Name, location or address, and Project number, f any) Sewer and Manhole Rehabilitation, Project No. 122-019 The Confactor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contactor and Surety bind themselves, their heirs, executors, administators, successors and assigns,jointly and severally, as provided herein. The conditions ofthis Bond are such that ifthe Owner accepts the bid ofthe Contactor within the time speoified in the bid documents, or within suoh time period as may be agreed to by the Ovmer and Contraotor, and the Contaotor eithor (l) enters into a contact with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contact Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contact and for the prompt paym€nt of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, bstween the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void othorwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Ovmer and Contactor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the biddocuments, and the Owner and Contactor shall obtain the Swety's oonsent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Confiactor, the term Contractor in this Bond shall be deemed to be Subcontactor and the term Owner shall be deemed to be Contaotor. (Witness) (Title)K. Hovden, CAUIION: You should sign an orlglnal AA Contrect Document, on whlch thlr lext appears ln RED, An odglnal lnlt. wlll not be obscurod. MMANBEOI-I123 POWER OF ATTORNEY SIRIUSPOINT AMERICA INSURANCE COMPANY NEWYORK KNO\\' Al,l, l\lDN By THESE PRESENTS: That SirirsPoinl America lnsurance Conrpany, a New York corporation, having its principal oflice in lhe City ofNew York, pursuant to lhe tbllorving Resolution, rvhich rvas adopled by the Board ofDireclors oflhe Conrpany, lo Nil: RESOI,\'ED, (hal lhc Presidenr, ScniorVice Presidcnt, ChielFinancinl O{licer, Secrelary or Assistanl Secreiary is hereby authorized lo execu(e Porvers ofAflomey appointing as allomeys-in-fact selecled enrployees of ceilain surety companies rvho shall have the porver for and on behalf oflhe Company lo execille and affix lhe seal oflhe Company lo surely contracts as co-surely. Does hereby nominate, constilute and appoinl: Christophcr K. Hovdcn, Angelica M. Lopcz Ils true and lawfrrl atlorney-in-fact, to nrake, execute, seal and deliver lbr and on i{s behalf, and as its acl anddeed; any and all bonds, contracts, agreenrents ofindemnity, and olher underlakings in suretyship (NOT INCLUDINC bonds Nilhoul a fixed penalty or financial gtaranlee boilds) and to bind th€Conrpany lhereby as fully and to the sanre exlenl as ifsame werc signed by the duly atxhorized olficers of lhe Company, provided, horveveq that tlre penal sum of any one such inslrunrent execrted hereunder shall nol €xceed the srnr of 550,000,000 single bond Iinrir All acts of said attonreys-in-f.cl pursuant to lhe aulhorities herein given are hereby ralified and confirnred. The execulive officeE listed above in the Rcsolulion nray lionr time to liDre and al any lime renrove any such appoinlee ard revoke the power given lo hinr or her. The execulion of such bonds or [nderlakings in pursuance of these presenls, silhin one ]rcar ofthe date of issue of these presenls, shall be trinding upon at ils office in New York, Nerv Yotk, in their orvnproper Jvsons. IN \YITNESS \YHEREOF, SiriusPoint Anrerica lnsurance Cornpany has caused ils corporale s€al to be h€reunto affixed, and lhese presents lo [re signed by ils Secr€tary this I ?lh day ofAugusl ir lhe year 2023. SiriusPoint Arncrica Company Mcliss Sccrclary Slare ofNcw Jersey l ) ... Counry ofMonmoulh ) On this I 7'h day of August 2023, belbre nre, a Notary Public of lhe Slate of Nerv Jersey in and lor the County of Monmoilh duly conrnrissioned and who excuted the preceding inslrumenl, and ackno$4edged the execution of lhe saDe, and, being by me duly sNonl, deFoselh and sailh, thal she is lhe officer oflhe Conpany aforesaid, and lhat lhe seal affxed lo lhe preceding inslnrmenl as lhc corpo.ale seal of said Company, and lhe said corporate seal and her signature as officer lvere duly aflixed and subscribed to lhe said instrnrenl by the authorily and direction of lhe said Conrpany, relcrred to in the precediilg inslrunrenl, is noN in lbrce- IN TESTIirtb)lY \YHEREOF, I have heretrnlo set nry hand and affixed nry oflicial seal. Ilv: TNAEJA E NOTARY PUBLIC STATE OF NEW JERSEY uv couuisbloN rxplRES MARCH 31' 2028 coMMlsslot{: f 5020854 1 expires l.lscl- ar. '5zt Slate ofNerv Jersey County of Monmornh l, Melissa J. Ralph, Secretary, ofSiriusPoirt America lnsurance Conrpany, a New York corporation, do heieby cerlify lhat lhe above and lbregoing is a full, ttuc correct copy ofPo\eerofAltonrey, is still in force and effect and has nol been revoked. fN\vltNllSS\\'Hl!Rf,On,Ihaveher€untosetnryhandandaffixcdthcscalofsaidConrpanythis 9th aayof, JUly, 2024 J, 1979 * I 3 16 CouNrY-CrrY BUTLDTNG 227 W, JEFFERSON B0ULEVARD SoUTH BEND, INDhNA 46601 -I 830 PHoNE FAx TDD Ctry or SourH BEND Jevps MUELLER, MRyoR Boa.nn oF PUBLIC WORKS 574/ 235-92sr 5741 235-9171 5741 235-5567 Date: To: From Subject Project Name Project No.: July 2,2024 All Planholders Theresa Heffrrer, Clerk, Board of Public Works Addendum Number: I Sewer and Manhole Rehabilitation 2024 t22-019 ACKI{OWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 7zt2o24 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works ^t (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. The attached documents are hereby added to the Specifications and Contract Documents and become apart of herein. Date: Company: Authorized Signature SewerandManholeRehabilitationBidAddendumNo. 1 Documentation Page 1 of8 PAST YEAR COMPLETED PROJECTS City of Waukesha 130 Delafield Street Waukesha, WI 53188 Contact: Chris Langemak Telephone: 262-524-3598 Contract Price: $1,380,000 Completion Date: Septemb er 2023 Class of Work: CIPP, Grouting & Manhole Rehab City of Milwaukee (Notice ll8-l-22) 841 N Broadway Street Milwaukee, WI 53202 Contact: Zafar Yousf Telephone: 414-286-2463 Contract Price: $588,000 Completion Date: August 2023 Class of Work: CIPP, Grouting & MH rehab Village of Constantine 115 White Pigeon Street Constantine,Ml 49042 Contact: Joseph Benjamin Telephone: 616-977 -1000 Contract Price: $71 8,000 Completion Date: Septemb er 2023 Class of Work: CIPP, Manhole Lining & Grouting City of West Allis 7525W Greenfield Ave West Allis, W 53214 Contact: Heath Brozovich Telephone: 414-302-837 6 Contract Price: $470,000 Completion Date: December 2023 Class of Work Grouting, Pipe Cleaning & Reaming City of Appleton 100 N Appleton Ave Appleton, WI 54911 Contact: Chad Weyenberg Telephone: 920-832-5915 Contract Price: $626,000 Completion Date: December 2023 Class of Work: CIPP City of Cumberland 950 1't Ave Cumberland,Wl 54829 Contact: JeffWolford Telephone: 920-621-0296 Contract Price: $728,540 Completion Date: May 2024 Class of Work: CIPP, Grouting, CCTV City of Madison 210 Martin Luther King Jr Blvd Madison, WI 53703 Contact: Kyle Frank Telephone: 608-266-4098 Contract Price: $974,000 Completion Date: Apil 2024 Class of Work CIPP Four Rivers Sanitation Authority 3501 Kishwaukee Street Rockford, IL 61109 Contact: Matt Campbell Telephone: 815-387-7684 Contract Price: $1,632,000 Completion DaIe: May 2024 Class of Work: CIPP, Grouting & MH Rehab PAST YEAR COMPLETED PROJECTS City of Janesville 18 N. Jackson Street Janesville, Wl 53547 Contact: Steve Jensen Telephone: 608-7 55-3172 Contract Price: $1,294,000 Completion Date: Apil 2024 Class of Work CIPP & Grouting City of Whittemore 315 Fourth Street Whittemore,IA 50598 Contact: James Zinnel Telephone: 515-884-2265 Contract Price: $603,000 Completion D aIe: June 2024 Class of Work CIPP, Grout, Point Repairs City of Mason City 10 First Street NW Mason City,IA 50401 Contact: Bill Stangler Telephone: 641-42I -3682 Contract Price: $3 14,000 Completion Date: June 2024 Class of Work CCTV & Pipe Cleaning Expected Class of Completion Job Number Construction Proiect Work Date Owner Name IN PROGRESS JOBS -23430W HoVMSD KAUKAUNA CIPP 111112025 HEARTOFTHEVALLEYMSD -23304w WAUWATOSA, WriCtTY OF CIPP / Grouting 111112024 CITY OF WAUWATOSA, Wl -23414W MAD|SON, Wt/CtTy OF UV #9335 clPP 31112025 crTY oF MADTSON, Wr -23420W ASHLAND,WI^ruTR&WASTEWATER CIPP/MH RehAb 31112025 CITYOFASHLAND,WI -24't7gM sUpERtoR, Wt CIPP / MH Rehab 21112025 clTYoF sUPERloR, Wl -24005w STUART tA CIPP / Grouting 121112024 CITY oF STUART lA -24158W FOX pOtNT, Wt crpp 111112024 clrY oF Fox PolNT, wl -23301W MoNoNA, tA/ctTyoF CIPP / Grouting 111112024 clTYoF MoNoNA, lA -23358W MEQUON, WI/CITYOF Grouting 121112024 CIryOF MEQUON, Wl -24177W MARSHFIELD Wl CIPP / Grouting 111112024 CITY OF MARSHFIELD Wl -23179W CRYSTAL LAKE, lA CIPP / Grouting 91112024 CITY OF CRYSTAL LAKE, lA -24014W MOUNT PLEASANT, Wl CIPP / Grouting 101112024 Clry OF MOUNT PLEASANT, Wl -240461A MASON Ctry, A ccTV 81112024 crTYoF MASON C|TY, rA -23194W W|LTON, TNCTTYOF clPP 101112024 clrYoFWlLToN, lA -24036W GLOBE CONT / SHOREWOOD Wl CCTV / Grouting 121112024 Clry OF SHOREWOOD, Wl -24047W INDEPENDENCE, IA / CITY OF CIPP 91112024 CITY OF CITY, WI 2600 N. 32nd Street Milwaukee, Wl The Master Lock Company 6744 S. Howell Ave, P. O. Box 927 Oak Creek, Wl 53154 John Ballogh 414-447-5472 Drew Setzer Visu-Sewer, lncorporated W230 N4855 Betker Drive Pewaukee, Wl 53072 262-695-2340 Phone 262-695-2359 Fax Apr-19 19122W 12"240 Drew Setzer Visu-Sewer, lncorporated W230 N4855 Betker Drive Pewaukee, Wl 53072 262-695-2340 Phone 262-695-2359 Fax Sep-19 19378W 8'506 Mequon, Wl MATC 700 West State Street Main Bldg, Room M70 Milwaukeee, Wl 53233 Kelly Cech 414-297-8478 8"2,541 Camp Chi Lake Delton, Wl JCC Chicago - Camp Chi 443 W. Munroe Ave. Lake Delton, Wl 53940 Steve Wilkins 608-852-7536 Drew Setzer Visu-Sewer, lncorporated W230 N4855 Betker Drive Pewaukee, Wl 53072 262-695-2340 Phone 262-695-2359 Fax Dec-19 19508W 8'264 Ocean Spray - Kenosha, Wl Ocean Spray Cranberries, lnc. Accounts Payable Mail Stop One Ocean Spray Drive Lakeville-Middleboro, MA 02349 Hanan AFRamahi 262-942-5308 Drew Setzer Visu-Sewer, lnc. 3155-104th Lane NE Blaine, MN 55449 763-252-0004 Phone 763-252-0008 Fax Jun-20 20306W I' 12', 456 457 Manitowoc, Wl Holy Family Convent 2409 So. Alvernor Rd. Manitowoc, Wl 54420 Joe Spurney 920-901 -3545 Drew Setzer Visu-Sewer, lnc. 3155-104th Lane NE Blaine, MN 55449 763-252-0004 Phone 763-252-0008 Fax Jun-20 20267W 30"852 Green Bay Sam's Club, Wl Apex Companies, LLC 3227 99th Street Urbandale, lA 50322 Matt Sheeder 515-727-8025 x 3305 Drew Setzer Visu-Sewer, lncorporated W230 N4855 Betker Drive Pewaukee, WI 53072 262-695-2340 Phone 262-695-2359 Fax Sep-20 20465W 945 585 Cedarburg, Wl Cedarburg Water Recycling Center W54 N370 Park Lane Cedarburg, Wl 53012 Dennis Grulkowski 262-375-7903 Drew Setzer Visu-Sewer, lncorporated W230 N4855 Betker Drive Pewaukee, Wl 53072 262-695-2340 Phone 262-695-2359 Fax Feb-21 21077W 8' 12" 338 428 Knowlwood Dr Wood Dale, lL F&M Building 2940 Commerce Street Franklin Park, lL 6013'1 Anthony Giannini 847-977-2020 Mike Bright Visu-Sewer of lllinois, LLC 9014 S. Thomas Avenue Bridgeview, lL 60455 708-237-0340 Phone 708-237-0360 Fax Oct-22 221941 IL JOB 12" REFERENCES - PRIVATE FIRMS Jan-23 23028W City of Cedarburg Wtr Recycl Ctr P. O. Box 49 W54 N370 Park Lane Cedarburg, Wl 53012 Dennis Grulkowski 262-375-7900 Drew Setzer Visu-Sewer, lncorporated W230 N4855 Betker Drive Pewaukee, Wl 53072 262-695-2340 Phone 262-695-2359 Fax 8"1,301 Cedarburg, Wl Aug-23 23350M 8' 10" 243 671 Cable, Wl Telemark lnterval Owners Assoc 15315 Nordmor Road Cable, Wl 54821 Kate O'Keefe (GM) 715-798-3999 Todd Stelmacher Visu-Sewer, lnc. 19587 Tamarack Street NW Oak Grove, MN 5501'l 763-252-0004 Phone 763-252-0008 Fax Oct-23 23409W 18'250 Kenosha, Wl Ocean Spray Cranberries 1 Ocean Spray Drive Lakeville-Middleboro, MA 02349 Bill Tucknott 262-942-5368 Drew Setzer Visu-Sewer, lnc. W230 N4855 Betker Drive Pewaukee, Wl 53072 262-695-2340 Phone 262-695-2359 Fax NATIONAL LINER RECOMMENDED SITE SURVEY PROCEDURES The purpose of a site survey is to identify potential problems, verify measurements, and provide detailed information concerning a line segment or job-site associated with the installation of a CIPP liner. The person or persons who will complete the site survey should have the following equipment: • Measuring wheel • 300 ft. Tape measure • 30 ft. Tape measure • Manhole Hook • Set of Calipers for pipe I.D. measurement • Air Blower • Gas Detector • Tripod • Safety Harness • Safety Lanyard Upon arrival at the job-site, the supervisor and crew should assess the need for traffic control during the site survey. If there is a need for traffic control, the supervisor will postpone the site survey until a traffic control plan is submitted and approved. Once traffic control is approved and set in place, the crew will proceed with the completion of the site survey. Note: Measurements taken inside manhole should be taken at upstream and downstream manholes. The completion of the site survey includes the following information: • Assess further traffic control needs (if necessary). • Measure line segment length and verify diameter of pipe at both ends. (See Line Measurement Procedure - CCTV Inspection section). • Test manhole for hazardous atmosphere. If the manhole is free of hazards, fill out "Confined Space Entry" form and enter manhole. • Verify diameter of pipe (Inlet and Outlet). • Assess bypass needs. • Assess fire hydrant locations. • Determine if there are overhead obstructions (upstream and downsteam). • Determine equipment placement during installation. NATIONAL LINER RECOMMENDED TRAFFIC CONTROL PLAN NOTE: Traffic Control Plans are generated after a visual inspection of the job site is completed when it is necessary. The traffic plan will be approved by the responsible city and/or state official before work on the job site is initiated. Need for Standards. Problems of traffic control occur when traffic must be moved through or around road or street construction, maintenance operations, and utility work. No one standard sequence of signs or other control devices can be set up as an inflexible arrangement for all situations due to the variety of conditions encountered. The following treatment of signs, signals, and markings for street and highway construction and maintenance work provides a comprehensive guide to be applied as a national standard. This part of the Manual establishes principles to be observed in the design, installation and maintenance of traffic control devices, and prescribes standards where possible, and is designed so that it can be used independently. These principles and standards are directed to the safe and expeditious movement of traffic through construction and maintenance zones and to the safety of the work force performing these operations. Traffic Cone Placement Scope. This part sets forth basic principles and prescribes standards for the design, application, installation, and maintenance of the various types of traffic control devices required for road or street construction, maintenance operations and utility work. These include signs, signals, lighting devices, markings, barricades, channelizing, and hand signaling devices. Minimum standards of application are prescribed for typical situations, and for methods of controlling traffic through work areas. Application of Standards. The general principles outlined in this manual are applicable to both rural and urban areas. Since it is not practical to prescribe detailed standards of application for all the situations that may conceivably arise, minimum standards are presented here for the most common situations. It is emphasized that these are minimum desirable standards for normal situations and that additional protection must be provided when special complexities and hazards prevail. The protection prescribed for each situation shall be based on the speed and volume of traffic, duration of operation, and exposure to hazards. As used in this part, the term street refers to all the streets in any municipality, including cities, towns, villages, or other local jurisdictions. Traffic conditions on streets are characterized by relatively low speeds, wide ranges of volumes, limited maneuvering space, frequent turns and cross movements, a significant pedestrian movement and other obstructions. Construction and maintenance operations are more numerous and varied, including such diverse activities as pavement cuts for utility work, pavement patching and surfacing, pavement marking renewal and encroachments by adjacent building construction. Work on arterial streets should be restricted to off peak hours to minimize conflicts with traffic. Rural highways are characterized by lower volumes, high speeds, and less interference from pedestrians, turns, and encroachments. Limited access highways present problems requiring a special effort by administrators, supervisors, and work forces. Both high speeds and high volumes may be anticipated, with peak flows restricting work to relatively short periods during daylight hours. The difficulties associated with the completion of work on lanes carrying high volumes of traffic have made it necessary in some instances to schedule construction and/or maintenance operations at night. While night scheduling avoids peak flows, the problems associated with work site delineation and warning device placement are increased. Although each situation must be dealt with individually, conformity with the provisions established herein is required. In particular situations not adequately covered by the provisions of this manual, the protection of the traveling public, pedestrians, and of the workmen on the scene will dictate the measures to be taken, consistent with the general principles set forth herein. Early project planning for traffic control in construction areas and implementation and surveillance of these controls during construction are very important. To facilitate adequate advance project planning, the plans, specifications and estimates (PS&E) for each project should include provisions for a reasonably specific traffic control plan for moving traffic through or around the construction zone in a manner that is conducive to the safety of the traveling public, pedestrians and workers. This traffic control plan should include, but not limited to, such items as signing; application and removal of pavement markings; construction; scheduling; methods and devices for delineation and channelization; placement and maintenance of devices; roadway lighting; traffic regulations; and surveillance and inspection. The high conspicuity of fluorescent orange colors provides an additional margin of safety by producing a high visual impact in hazardous areas. Therefore, where the color orange is specified for use in traffic control for construction and maintenance operations, it is acceptable to utilize materials having fluorescent red-orange or yellow-orange colors. Responsibility. The provisions for public protection established herein are for application by (1) state highway department, county, and municipal forces performing construction or maintenance operations on roads and streets, (2) contractors employed in road or street construction or maintenance under contract to any governmental authority, and (3) all others, including employees of public utility companies, performing any work on highways or so closely adjacent as to create hazards for the public or for themselves. These standards, as part of the manual on Uniform Traffic Control Devices, should be adopted by all public authorities concerned with highways, and should be given effect by official instructions to employees and by incorporation into the specifications for all contracts. It is important that the authorities having jurisdiction be able to require proper protection, that responsibility be clearly assigned, adequate training of personnel be provided, and that there be adherence to the standards and provisions of this manual. Fundamental Principles. All traffic control devices used on street and highway construction or maintenance work shall conform to the applicable specifications of this manual. Construction and maintenance areas can present to the motorist unexpected or unusual situations as far as traffic operations are concerned. Because of this, special care should be taken in applying traffic control techniques in these areas. Experience has shown that principles and procedures tend to enhance the safety of motorists and workers in the vicinity of construction and maintenance work areas include the following: • Traffic safety in construction zones should be an integral and high priority element of every project from planning through design and construction. Similarly, maintenance work should be planned and conducted with the safety of the motorist, pedestrian, and worker kept in mind at all times. • The goal should be to route traffic through such areas with geometrics and traffic control devices as nearly as possible comparable to those for normal highway situations. • A traffic control pan, in detail appropriate to the complexity of the work project, should be prepared and understood by all responsible parties before the site is occupied. Any changes in the traffic control plan should be approved by an official trained in safe traffic control practices. • Traffic movement should be inhibited as little as practicable. • Traffic control in work sites should be designed on the assumption motorists will only reduce their speeds if they clearly perceive a need to do so. • Frequent and abrupt changes such as lane narrowing, dropped lanes, or main roadway transitions which require rapid maneuvers should be avoided. • Provisions should be made for the safe operation of work vehicles, particularly on high speed, high volume roadways. • Construction time should be minimized to reduce exposure to potential hazards. • Motorists should be guided in a clear and positive manner while approaching and traversing construction and maintenance work areas. • Adequate warning, delineation, and channelization by means of proper pavement marking, signing, and use of other devices which are effective under varying conditions of light and weather should be provided to assure the motorist of positive guidance in advance of and through the work area. • On short term maintenance projects, it may be determined that such removal is more hazardous than leaving the existing markings in place. If so, special attention must be paid to providing additional guidance by other traffic control measures. • Flagging procedures, when used, can provide positive guidance to the motorist traversing the work area. Flagging should only be employed when required to control traffic or when all other methods of traffic control are inadequate to warn and direct drivers. • To ensure acceptable levels of operation, routine inspection of traffic control elements should be performed. • Job site supervisors are assigned responsibility for safety at work sites. The most important duty of these individuals is to ensure that all traffic control elements of the project are in conformity with the traffic control plan and are effective in providing safe conditions for motorists, pedestrians, and workers. • Modification in traffic controls or working conditions may be required in order to expedite safe traffic movement and to promote worker safety. It is essential that the individual responsible for safety have the authority to control the progress of work on the project in its relation to obtaining safe conditions, including the authority to modify conditions or halt work until applicable or remedial safety measures are taken. • Work sites should be carefully monitored under varying conditions of traffic volume, light, and weather, to ensure that traffic control measures are operating effectively and that all devices used are clearly visible, clean, and in good condition. • All traffic control devices shall be removed immediately when no longer needed. • The maintenance of roadside safety requires constant attention during the life of the construction or maintenance zone because of the potential increase in hazards. • Channelization of traffic should be accomplished by the use of pavement markings and signing, flexible posts, barricades, and other lightweight devices which will yield when hit by errant vehicles. • Whenever practical, construction equipment, materials, and debris should be stored in such a manner as not to be vulnerable to run off the road vehicle impact. RECOMMENDATIONS FOR SEWER LINE CLEANING INTENT The intent of sewer line cleaning is to remove foreign materials from the lines and restore the sewer to the original carrying capacity. Since the success of the other phases of work depends a great deal on the cleanliness of the lines, the importance of this phase of the operation is emphasized. It is recognized that there are some conditions such as a broken pipe and major blockages that prevent cleaning from being accomplished or where additional damage would result if cleaning were attempted or continued. Should such conditions be encountered, the contractor should seek further advice from the owner. CLEANING EQUIPMENT High-Velocity Jet (Hydro cleaning) Equipment: All high-velocity sewer cleaning equipment shall be constructed for ease and safety of operation. The equipment shall have a selection of two or more high-velocity nozzles. The nozzles shall be capable of producing a scouring action from 15 to 45 degrees in all size lines designated to be cleaned. Equipment shall also include a high- velocity gun for washing and scouring manhole walls and floor. The gun shall be capable of producing flows from a fine spray to a solid stream. Mechanically Powered Equipment: Bucket machines shall be in pairs with sufficient power to perform the work in an efficient manner. Machines with direct drive that could cause damage to the pipe should be avoided. A power rodding machine shall be either a sectional or continuous rod type capable of holding a minimum amount of rod to complete the line segment. The rod shall be specifically heat treated steel. To insure safe operation, the machine shall be fully enclosed and have no automatic safety clutch or relief valve. CLEANING PRECAUTIONS During sewer cleaning operations, satisfactory precautions shall be taken in the use of cleaning equipment. When hydraulically propelled cleaning tools (which depend upon water pressure to provide their cleaning force) or tools which retard the flow in the sewer line are used, precautions shall be taken to insure that the water pressure created does not damage or cause flooding of public or private property being served by the sewer. When possible, the flow of sewage in the sewer shall be utilized to provide the necessary pressure for hydraulic cleaning devices. When additional water from fire hydrants is necessary to avoid delay in normal work procedures, care should be taken not to block access to the fire hydrants in case of fire in the area served by the hydrant. SEWER CLEANING The designated sewer manhole sections shall be cleaned using hydraulically propelled, high-velocity jet, or mechanically powered equipment. Selection of the equipment used shall be based on the conditions of lines at the time the work commences. The equipment shall be capable of removing dirt, grease, rocks, sand, and other materials and obstructions from the sewer lines and manholes. If cleaning of an entire section cannot be successfully performed from one manhole, the equipment shall be set up on the other manhole and cleaning again attempted. During initial stages of cleaning, low flow rates can be helpful. On final cleaning, the line segment should be completely isolated. ROOT REMOVAL Roots shall be removed in the designated sections where root intrusion is a problem. Special attention should be used during the cleaning operation to assure almost complete removal of roots from the joints. Any roots which could prevent the seating of sealants of the packer or could prevent the proper application of chemical sealants shall be removed. Procedures may include the use of mechanical equipment such as rodding machines, bucket machines and winches using root cutters and porcupines, and equipment such as high-velocity jet cleaners. Chemical root treatment may be used at the option of the owner. MATERIAL REMOVAL Debris such as dirt, sand, rocks, grease, and other solid or semisolid material resulting from the cleaning operation shall be removed at the downstream manhole of the section being cleaned. DISPOSAL OF MATERIALS Debris removed during sewer line cleaning shall be disposed of at only approved and/or specified sites in strict accordance with all local, state, and federal regulations. RECOMMENDED LINE MEASUREMENT PROCEDURES When the initial T.V. inspection is done, the following procedures will be followed after setting up on upstream manhole. (Refer to Diagram) Measure Depth of Manhole: This is done by measuring from the bottom of the invert to the top of the ring. Center to Center: To obtain, measure from the inside ring of the upstream manhole to the outside ring of the downstream manhole. Pipe Size: Two measurements will be taken from about 6-10" inside pipe when edges are broken. On lines 8-24", inside calipers will be used. On lines larger than 24", a tape can be used but always get two measurements. These two measurements should be taken from any of the following clock positions: 12-6; 9-3; 8-2; 10-4. Location of Service: You will also already have your KEVLAR tape attached to your camera. As your camera approaches each service, rotate the camera to look exactly at the center of the service and record the KEVLAR tape measurement from an established reference point. Record the camera footage on the front of th T. V. Report and the KEVLAR measurement is on the back of the T. V. Report. NATIONAL LINER RECOMMENDED RESIN, CATALYZATION & MIXING PROCEDURE SAFETY • Each of the cure chemicals should be weighed in separate containers and containers should not be interchanged unless thoroughly cleaned. Cobalt Naphthenate should never be mixed directly with any peroxide since this could result in a strong exothermic reaction and/or fire. • Keep peroxides out of direct sunlight. Ultraviolet light emitted from the sun may reduce the activity of the peroxide, which will reduce the effectiveness of its ability to cure the resin. The combination of heat and ultraviolet light from the sun may lead to rapid peroxide decomposition resulting in heat and/or fire. • Always follow manufacturers' instructions for peroxide storage conditions and maximum upper temperature limits of storage. Follow resin manufacturers' recommendations for resin storage life and conditions of storage (See Resin and Materials Handling Section of each Material Safety Data Sheet) • Wear protective eye wear, gloves, clothing, and organic respiratory equipment, as necessary and as required by local, state and federal regulations. DOCUMENTATION When calculating quantities of resin and cure ingredients, special care should be taken to ensure that all the chemicals have been properly weighed, added, and mixed together. To help eliminate errors, it is recommended that only one individual be given the responsibility of calculating, weighing, and mixing in the cure chemicals. In addition, detailed information about each wet out and catalyst mix should be recorded and kept as one part of record retention and quality control. The type of information that is helpful includes: • Job specifics (project, manhole sections, pipe/tube length, etc.) • Process Times (beginning, end, specific mix times, pumping, etc.) • Process Temperatures (air, chemicals, pre and post-mix resin temperature, tube storage) • Gel time test information • Special Considerations (use of ice, equipment problems, delays) The wet-out Request and Wet-out Report are examples of the type of information that is helpful. RESIN HANDLING MATERIALS & MATERIAL INTERACTIONS Styrene based polyester resins are sensitive to contact with red metals and heavy metals. In some cases interaction with these metals will inhibit the cure of the resins, while in other cases it has been observed to uncharacteristically accelerate the cure. Commonly found metals or metal coatings to avoid are: copper, brass, beryllium, chromium, lead, and zinc (galvanized metal). Recommended choices for metals or plastics to be used for storage and/or piping include carbon steel, stainless steel, aluminum, polyethylene, polypropylene, and Teflon. Flexible resin transfer hoses must be made of chemically resistant materials that are recommended for use with styrene monomer. Pumps and gasket materials must also be approved for use with styrene monomer. RESIN QUANTITY DETERMINATION Before one can catalyze or mix the resin, it is necessary to determine the quantity of resin required for the specific tube being prepared. • First, determine the diameter, thickness and length of tube to be prepared. • Using the manufacturer’s approved charts for the given resin, obtain the approximate pounds of resin per linear foot for a given tube thickness and diameter. Multiply this value by the length of tube to estimate to total quantity of resin for the mix. Note that variations in the tube, as well as resin density, varies due to temperature and manufacturer. It is due to the differences in resin density that various charts are necessary for the different resins to estimate resin use per linear foot of tube. • Where multiple resin injections are necessary, one can closely estimate resin usage/foot by dividing the quantity of resin consumed by the number of feet wet- out. Occasionally resin usage will vary from that given in the attached table because of variations in resin density and/or roller gap settings at the wet out conveyer. Using an in-process calculated figure for the pounds of resin used per linear foot will verify the accuracy of the value given in the table. If for some reason the resin usage varies slightly from that given in the table, then the in- process figure will provide a more accurate calculation of the quantity of resin to complete the wet out. Calculating resin usage in this manner will increase the accuracy of the wet out thereby saving time and/or resin. SPECIFIC CURE CHEMICAL ADDITIONS In order to determine the cure chemical mixture, one must first reference the resin manufacturer guidelines for the recommended catalyst formulations. Concentrations of chemical ingredients are modified in order to chemically control the curing heat of reaction that is produced by the resin when it is transformed from a liquid to a solid. Increasing the amount of peroxide used increases the amount of heat generated during the curing process. In addition to controlling the heat liberated, adjusting the catalyst mixture also affects the time before the resin will gel, and this is often referred to as "gel time." Once the proper chemical formulation ratios have been chosen and the weight of resin in the drum is known, one may calculate the amount of cure chemicals necessary for each mix. Document and record this information. SPECIFIC MIXING INSTRUCTIONS (Inline Mixing) • Store the resin in the recommended temperature range as per the resin manufacturer’s guidelines. Before mixing any chemicals measure and record the resin temperature and the time. • Start resin pump and circulate resin within the bulk storage system. • Weigh the calculated amount of each catalyst. Be aware that the Perkadox 16 is a powder and must first be dissolved before being introduced into the resin. Styrene monomer has been found as a suitable solvent to accomplish this task. In order to fully dissolve the Perkadox 16, use styrene at a 1:1 ratio by weight of Perkadox 16. • Mix the catalysts and dye in an appropriate container until thoroughly mixed. For the catalyzation, add the chemicals separately in the following sequential order: • Styrene Monomer / Trigonox KSM or other secondary catalyst • Perkadox 16 / or other primary catalyst • 1 cc of dye per pound of Perkadox 16 After the Perkadox 16/styrene monomer/Trigonox KSM solution has been mixed thoroughly, filter the solution through an appropriate screen and pour into the catalyst hopper. Start the catalyst pump in the re-circulation mode. Take the time vs weight calibration sample as per manufacture’s directions. Zero the resin totalizer. Set the catalyzation rate (ml / min) as per manufacturer’s recommendations). Turn switch from Re-circulation to Dispense. Take a resin sample every 500 pounds for a gel test (see RESIN SAMPLING & GEL TIME TESTING). SPECIFIC MIXING INSTRUCTIONS (Drum Mixing) • Store the resin in the recommended temperature range as per the resin manufacturer’s guidelines. Before mixing any chemicals, measure and record the resin temperature and the time for that drum. • Set the mixing blade in the drum to a depth of approximately three-fourths (¾) of the way to the bottom. Adjust the rotational speed of the mixing shaft to establish a circular vortex in the resin that extends approximately one-fifth (1/5) of the way down the shaft from the top of the resin. Do not allow the surface of the mixing blade to be exposed by generating a strong vortex, because this will entrain air bubbles into the resin. If the maximum speed does not allow for an adequate vortex then the blade diameter should be increased. • Weigh the calculated amount of each catalyst. Be aware that the Perkadox 16 is a powder and must first be dissolved before being introduced into the resin. Styrene monomer has been found as a suitable solvent to accomplish this task. In order to fully dissolve the Perkadox 16, use styrene at a minimum of 1.0-2.0 times the weight of Perkadox 16. • For the catalyzation, add the chemicals separately in the following sequential order and mix each chemical 1-2 minutes before adding the next ingredient: • Perkadox 16/styrene monomer solution or other primary catalyst • Trigonox KSM or other secondary catalyst • 1 cc of dye per pound of Perkadox 16 After the Perkadox 16/styrene monomer/Trigonox KSM solution has been mixed thoroughly, filter the solution with an appropriate screen. The resin & catalyst solution should be mixed for approximately 7-10 minutes. After mixing, obtain a sample for gel time testing and once again measure and record the temperature of the resin and the time. The resin temperature should still be cool (i.e. 55-60ºF), but will probably be slightly increased compared to the original measurement. Once the temperature is verified to be acceptable, pump the resin into the tube. If the resin temperature is greater than 70ºF, take special precautions to ice the tube as it is loaded into the truck. Note: When mixing in 55-gallon drums, the number of mixes required for any given wet out is often increased and this can lead to errors or mistakes in resin catalyzation. In the event many people get involved with the wet out, delays or equipment failures may distract the wet out supervisor and result in mixing errors. Therefore, it is strongly recommended that the wet out supervisor develop a system for marking the drums as each chemical is added in order to avoid double chemical additions and/or leaving a chemical out. For example, when the Cobalt Naphthenate is added, spray paint a "C" on the drum, when the Trigonox KSM is added, spray paint a "T" on the drum, and a "P" for the Perkadox 16. RESIN SAMPLING & GEL TIME TESTING Prior to pumping the resin into the tube, obtain a sample from each drum or every 500 pounds of inline mixer for gel time testing. Gel time testing is strongly recommended in order to verify that the resin has been properly catalyzed and mixed. In addition, performing gel time tests will provide a quality record that may be required by the owner and/or provide the necessary information for solving unanticipated problems that may be encountered during the wet out or in the field. Pre-heat the water bath between 160-175ºF. For consistent comparison and quality control, heat the water bath to the same temperature every time. Before filling the 50 ml test tubes with resin, position the thermocouple wire within 1 inch of the bottom of the tube. Fill the test tubes with 3.5 inches of resin and immerse into the water bath to a depth of 2.5 inches. Record the rise in temperature and the exothermic event with a chart recorder for your permanent records. After the resin has exothermed and looks consistent with previous gel time test data it can be pumped into the tube for the wet out procedure. After the cure is complete, leave the test tube in the water bath for 10-15 extra minutes to verify that the resin cure rises up the test tube in the 1-inch portion left above the level of water. This type of curing can sometimes simulate the type of cure one might expect in lateral lines or manholes in the presence of water. CLEAN UP AFTER MIXING Good housekeeping in the resin mixing and wet out areas is essential in order to avoid loss of material and major mechanical problems with the pumps and associated valves. Catalyzed resin left in pumps, hoses and vessels continues to cure and will eventually get rock hard. If the temperature in the mixing area is high, this process will be accelerated. The purpose of good cleaning habits is to avoid mixing partially gelled chunks of resin with freshly catalyzed resin that would be put into a liner. Gelling particles or chunks of resin act like tiny hot spots that could spread throughout the tube and result in the loss of a liner before installation has been completed. In addition, keeping clean equipment also allows one to change between different resin or cure systems without having to worry about cross contamination that could affect liner curing and/or quality. If mixing directly in 55-gallon drums tip each drum up-side-down to thoroughly drain the resin. This will help with drum recycling or disposal, as well as utilizing all the resin available. Thoroughly drain all hoses and transfer pumps of catalyzed resin. As part of a regular maintenance program, the diaphragm pump should be broken down on eek and completely cleaned to avoid resin build up on the diaphragm and the balls. RECOMMENDED WET OUT PROCEDURE SAFETY CONSIDERATIONS The wet out process involves a number of different tasks that have their own safety concerns. For the catalyzation, mixing and transferring of resins, refer to the " Mixing Procedures" for the recommended safety considerations involved with handling and exposure to the resins and catalyst chemicals. The process of wetting out the tube may have the following safety concerns: • When a moving conveyer belt is being used for the wet out, it is recommended that personnel move onto and off the belt when it is stationary. • All moving conveyers should have a shut down cable that extends the length of the belt and is easily accessible. • When moving the tubes onto or off the conveyer, take proper precautions for lifting and loading. Large diameter tubes saturated with resin are quite heavy and must be lifted and loaded mechanically to avoid back and pinching injuries to personnel. RESIN TRANSFER PIPE PLACEMENT • Determine the Center of the Tube -- Prior to placing the resin transfer pipe into the liner, it is extremely important to count the number of polyester felt layers used to compose the tube so that the resin is injected into the middle of the tube. Failure to properly inject the resin into the center of the tube will adversely affect the wet out and slow it tremendously. Injecting the resin between the wrong layers causes the felt layers to act as a filter and the resin must pass through an extra layer on one side of the tube to fully wet out that side. • Transfer Pipe Placement -- Once the felt layers of the tube are counted, the resin transfer pipe should be inserted approximately 2-4 feet into the center of the secured and elevated tube through the burp tube. Secure the resin transfer pipe above the tube with a rope or clamp to insure the pipe will not back out of the tube during the filling process. The use of diaphragm pumps for resin transfer typically causes the resin transfer pipe to jump up and down. Securing the hose will prevent excessive movement and spills. The transfer hose itself is typically 1.5-2.0 inches diameter chemical hose suited for service with styrene monomer and intermittent contact with solvents such as acetone. APPLICATION OF VACUUM The first step to a successful wet out is to obtain a good vacuum on the tube. The purpose of the vacuum is to remove all the air from the tube and displace it with resin. As the tube moves past the pinch rollers, resin is forced back into the area of the tube evacuated by the vacuum. 1. Vacuum Equipment -- Although there are several means to achieve good vacuum on the tube, placing vacuum sources and sealing around the vacuum sources in the end of the tube is recommended. Also, placement of a vacuum hose to attach to the resin transfer pipe is necessary. Note: It is highly recommended to have a backup vacuum pump in the event of failure of the primary vacuum pump. Tube Preparation -- Start preparing the tube by sealing the tail end (last part to be wet out) of the tube. Although several methods can be used, sealing the end with duct tape has been found to be quite simple and effective. At the front end of the tube, where the wet out will start, this end will be sealed around the resin transfer hose with the soft end and/or duct tape. In addition, the tube should be sharply kinked or folded back 180 degrees on itself just beyond the end of the resin transfer hose. Kinking the tube will stop the resin from freely flowing into the tube until the vacuum fully saturates the entire cross sectional area of the tube in the area of the fold. PREPARE RESIN FOR WET OUT Once the tube has been prepared as described previously, catalyze and mix the resin as outlined in the Mixing Procedures. START UP/INITIAL TUBE FILLING When the vacuum has been applied and the tube has been prepared as described previously, the tube is ready for filling. Begin pumping resin until the resin nears the resin transfer pipe. Slowly fill the area of the tube behind the kinked portion of the tube with the catalyzed resin. Once the resin fully saturates the entire cross section of the felt tube, the vacuum on the tube should become noticeably stronger. As the vacuum becomes stronger the resin front should become visible past the clamped area and will creep down the tube at a discernible rate. Full saturation is obvious as the darker resin fills and replaces the snowy white appearance of the felt tube. Areas that are not properly wet out appear as snowy white patches or blotches on the surface of the tube. An ideally wet out tube has no white spots at all. Do not remove the vacuum to dissipate the vacuum in the tube and allow the resin to freely run down the tube. Relieving the vacuum in the tube and allowing it to run will create white patches that will never become fully saturated with resin. If possible, the tube should be filled with the calculated estimate of resin necessary to saturate the entire length of liner to be installed. Do not overfill the unrestrained tube on the belt as this may stretch the felt liner and result in wrinkles in the final CIPP. When the calculated estimate of resin necessary for the entire wet out exceeds the initial filling constraints, multiple resin injections are necessary. See Section for the recommended procedure on multiple resin injections. After the tube has been filled with the calculated estimate of resin, the resin transfer hose is removed and the end of the bag sealed. Duct tape has been found to work well for closing off the end of the liner. Sealing the end of the tube serves two purposes. First, it prevents excess resin from spilling out in the wet out area during the completion of the wet out and loading of the liner. Second, the sealed end will prevent water and debris from entering into the tube as it is lowered through the manhole and into the host pipe. MULTIPLE RESIN INJECTIONS INTO THE TUBE When it is not possible to pump all the resin into the tube at one time, multiple resin injections must be made to saturate the entire length of the tube. After the initial resin filling and sealing of the tube, the liner wet out will proceed using the resin in the liner. As the resin slug is absorbed by the felt, it will become quite small. At the point when the resin slug extends approximately 5-10 feet from the pinch rollers and is relatively small in the tube, the wet out should be stopped for a second injection of resin. Always inject resin above the slug so that filling can continue without affecting the vacuum on the liner. Where possible, the tube should be elevated in the area of the injection to prevent the pumping resin from backing out the cut used for the injection. Use the following recommended procedure for injecting resin into the tube at an intermediate point along the liner: • On either side of the seam, near the center of the tube, make a slit into the tube just large enough for the transfer pipe or hose. The slit should be along the length of the tube. • Verify that the slit has been made through the appropriate number of layers of felt to expose the center of the tube. Insert the transfer pipe or hose into the center of the tube. • Use a board or pipe pried under the tube to elevate the liner slightly (if possible) for improved resin transfer and pump the required resin into the tube. • Close the slit by using a large sewing needle and 0.125 in. braided twine to sew the opening closed in a pattern similar to that of a laced shoe. Tightly tie off the twine and place two, the second larger than the first, PU patches over the slit and seal with THF. If the resin is allowed to be completely consumed and the injection is made below the resin face in dry felt, the procedures for initial filling will be required because the vacuum will have been lost in the tube. PINCH ROLLER GAP SETTING As the resin slug moves down to the end of the wet out conveyer, the tube is ready to move through the gapping rollers and onto the transporting vehicle. The roller gap setting should be set according to the liner manufacturer’s recommendations. Although, field conditions must also be considered to determine the gap setting that will produce the desired end result. This roller gap setting has been chosen to allow for full wet out of the felt layers of the tube as it is wet out. The most reliable method of setting the gap distance is to produce a set of shims of the appropriate thickness and put them between the rollers to gauge the distance. When the shim fits snugly between the rollers the setting is correct and the wet out is ready to proceed. Check to insure that the rollers are centered and not out of round. It is recommended to check the gap setting every 100 feet as the liner is being wet out. Roller Gap Setting BELT SPEED The belt speed must be set to an acceptable rate that allows for a full and complete wet out to be accomplished. Moving the belt more slowly is always preferable. Keep personnel off the tube at all times. It is not necessary or efficient to have wet out personnel walking or jumping on the tube to aid in tube saturation. When personnel walk on the tube, the resin slug typically jumps ahead too quickly for the vacuum and results in unsaturated portions of the tube. Check Belt Speed LINER MEASUREMENT DURING WET OUT As the liner moves forward along the belt, it is very important to obtain proper measurements of the liner. Although all the tubes are marked every 5 feet, it is possible for measuring errors to occur. Measurements on the tube itself only need to be marked every 25 or 50 feet. It is also advisable to document the footage so that all recordings are duplicated. TROUBLE SHOOTING Slow or Stopped Wet Out 1. Check Vacuum - First check the vacuum on the tube, because poor vacuum will slow the wet out and produce a lot of unsaturated spots on the tube. If the tube is not tightly compressed check all areas where the liner is losing air. The following list is the most common problem areas: • Check that all vacuum lines are securely attached. • Make sure the end of the tube is sealed. • Are there any leaking joints below the resin slug? • Verify that all seams are secure. 2. Verify Location of Resin Injection - A second cause of a stopped wet out occurs when resin has not been injected into the center of the tube. In general, the occurrence of such a problem usually follows a resin injection at an intermediate point along the wet out liner and the cut was not made in the center of the tube. If it is found that the wet out is proceeding uncharacteristically slow, verify that the resin was injected into the center of the tube by opening up the injection site and counting the layers and/or roughly measuring the thickness of the felt layers. Injection anywhere other than the center of the tube will cause problems. Although it is not easy, the problem can be corrected. First use a board by cutting through the appropriate number of felt layers exposing the center of the liner just in front of the slug of catalyzed resin. The slug of resin can then be slowly pushed forward through the cut. White spots on top and/or under the tube or a short (i.e. 5-10 feet) section with white spots • Check Belt Speed--One possible cause may be that the belt is moving too quickly and pushing the resin into the tube faster than the vacuum can fully saturate the felt. Slow the belt down and check the vacuum spikes to eliminate leaks. • Lost Vacuum--If one of the vacuum hoses becomes plugged with resin or is pulled away from the tube and not noticed, vacuum on the tube may be lost. When this occurs, the weight of the resin slug overcomes the force holding the tube together and the resin will quickly move down the tube without saturating the felt. When this occurs, physically stop the resin slug and the belt, and re-establish the vacuum. If possible, check the underside of the tube as it moves off the belt to determine if this area of the tube also has areas that are not saturated. Failure to monitor the wet out may produce a number of problems in the field that will show up at the post inspection. Poorly saturated spots on the liner will not cure properly or have the physical properties to sustain the external hydrostatic water pressure. This would show up as a lift or bump that is soft. Correcting these problems is costly and unnecessary. RECOMMENDED BY-PASS PLAN PROCEDURE NOTE: By-pass Plans are generated after a visual inspection of the job site is complete. When it is necessary, the By-pass Plan will be approved by the responsible City and/or State official before work on the job site is initiated. The assessment of the necessary by-pass plan includes the following steps: • Establish the flowrate within the pipeline section which is to be bypassed. • The best way to do this is by physical measurement with the pipe full to various depths. There are a range of instruments on the market to do this, but it may not always be possible to make measurements with the pipeline filled to a range of depths, and you may have to use other methods. • Many cities keep records of the flowrate within their wastewater systems, and you may be able to obtain accurate values of the flowrate within a given pipeline by contacting the appropriate City department. • Based on these calculations, establish what maximum flow volume the pumps will have to handle at the maximum pipeline capacity. • Determine the type, length and number of bypass lines to be used. • Once you have established the maximum flowrate which is to be handled by the bypass pump(s),you will need to make a preliminary estimate of the bypass pipe arrangement which will be necessary to handle this flow. Use the attached manufacturer’s data tables and/or graphs to determine the pressure loss encountered over the necessary length of line, and add the suction lift and pressure losses due to bends in the bypass lines if applicable. Avoid selection of a line size that operates at or near its maximum flow capacity, as this may correspond to the maximum pressure rating of the line material, and will prevent any increase in volume pumped if it should become necessary. • Straight Pipe Flow of liquid in HDPE pipe can be represented by the Hazen Williams formula. Where hf = head loss in feet of water per 100 feet of pipe C = Roughness Coefficient Q = Flow in US Gallons per minute D = Internal Diameter of Pipe in inches C values are typically about 150 for HDPE pipe, but may fall to 140 if the pipe contains many butt fusion welds; for forced sewage applications, 130 is recommended. • Select a Pump • Refer to manufacturer’s data curves for the pump types available to determine which one(s) are required to deliver the flow volume applicable at the pressure required. RECOMMENDED INSTALLATION PROCEDURES The following installation recommendations are a set of installation options that have been used successfully to install cured-in-place pipe. In most cases the installation practices described below may have a considerable factor of safety built into the procedure. There are clearly many other possible variations of these described practices that may be more effective and/or efficient for installing a cured-in-place pipe. However, it is strongly recommended that inexperienced installers follow the guidelines outlined below or the guidelines personally conveyed by experienced personnel in order to avoid unnecessary problems during the installation of the cured-in-place pipe. As these techniques are reviewed, they may be added into this procedural document as improvements to the system. LAY FLAT HOSE & HOLD BACK ROPE Materials -- The circulation hose system necessary to properly circulate water for curing a tube should be made up of three different types of hose materials. The out flowing water hose, going from the heater to the layflat hose, should be a heavy duty hose capable of handling at least 100 psi at 212 degree F. This hose should be a semi-rigid material that can withstand the bending and twisting it will experience. The high temperature hose then should be connected to reinforced blue PVC (Layflat) hose rated for 50 psi. This hose works well at high temperatures as long as it is not kinked or stretched and should therefore be measured so that it only extends within the pipe or liner itself. In general, both types of hose material should be the same diameter and be connected by a spliced joint or hose mender. The third type of hose material is the suction hose, which returns the water from the water column back to the water heater. This hose must be rigid (but flexible) and capable of withstanding internal vacuum forces at elevated temperatures of 212ºF. It is recommended that the suction hose should meet or exceed the following specifications: Black EPDM tube and cover, multiple textile plies with helix wire, and a temperature range of -30ºF to 300ºF. The hold back rope ideally should be a stable braid polyester low stretch rope suitable for high temperature use. For liners up to 36 inches in diameter, the rope may be 0.625 inch. For larger diameter pipe, the rope should be at least 1 inch in diameter. Lay Flat Configuration & Measurement -- The lay flat or circulation hose preparation and measurement is one of many critical steps in materials preparations for installing a tube. The length of blue lay flat hose should be estimated by adding the center-to-center measurement of the line plus the column height plus an additional 10-20 feet and subtracting 5 feet for the turn- back on the liner to ensure the length is adequate. The heavy-duty high temperature hose length should be determined by adding 10 feet to twice the length of the column and any additional distance necessary to connect to the water heater. Lay Flat Hose Splicing -- Each lining section should have a maximum of three splices per lining segment. Old, worn and stretched circulation hose should be discarded and replaced with new or undamaged hose. Damaged hose and/or too many splices may result in poor circulation or may separate during the installation procedure. Although service and installation conditions vary, typical PVC based blue lay flat discharge hose can be used for quite a number of installations before it must be replaced. Splicing hoses together is an easy procedure, but the direction of the splice is critical for proper circulation. When splicing two hoses together always place the hose with out flowing water approximately 8- 12 inches inside the hose receiving the water. All subsequent splices on a section of layflat must be made in a similar manner. To complete the splice use a 0.25-inch hole punch or drill bit to make eight holes, four on each side, spaced approximately 2 inches apart and approximately 0.5 inch in from the edge of the outer hose. The holes must extend through both hoses. Then, using eight pieces of 0.188-inch nylon rope individually tie the ropes through each set of overlapped holes and secure with locking knots. If the hose is positioned incorrectly with the out flowing water hose over the outside of the receiving hose, the receiving hose will collapse and circulation will not extend beyond that point in the tube. In addition, when pieces of previously joined lay flat hose are being mended together, the splicing direction must be an essential area of attention. For installations of 12" diameter and above, an alternate method of splicing the circulation hose is “hard-splicing”. This is accomplished by splicing two circulation hoses by means of a hose-barb fitting. First, the end of the first hose is placed over half the length of the fitting from the inside. Punch holes in the hose approximately ½" from the end of the hose-barb fitting and insert ropes through the hole and out the end of the fitting. Next, punch holes in the second hose approximately where holes were punched in the first hose. Pull the ropes inserted in the first hose through the holes in the second hose. NOTE: The holes punched in the hoses must be opposite of each other (i.e., 12 o’clock and 6 o’clock). Pull the second hose on the hose-barb fitting. Using 3/4" banding strap, place two 3/4" stainless steel doubled bands around each hose on the fitting. Wrap the banding with electrical tape to ensure the bands do not puncture the polyurethane coating on the liner. Tie the ropes that are connecting to the two hoses and wrap with duct tape. A last step in the process of preparing the circulation hose(s) is to punch 0.25-inch diameter holes in the hose every 10-12 feet along the length of the blue lay flat discharge hose. Drilling or punching holes every 4 long paces along the length of the discharge hose may approximate this. These additional holes will allow some of the water to push out along the liner and also increase water movement along the liner. Lay Flat End Preparation -- The end attachment of the blue lay flat hose that is to be connected to the liner must be done differently, depending on the size of the liner being installed. For small diameter, lay flat can be folded back over itself to make a cuff at the end of the hose. Punch holes in the end. Nylon ropes can be secured at each hole to make loops by which the lay flat can be attached to the end of the liner. Preparing the circulation hose in this manner allows the hot water to eject directly out the open end towards the end of the installed liner. Alternately, attach a steel or plastic sleeve in the end of the lay flat hose. This will allow the full amount of hot water to be discharged directly towards the end of the liner. For larger diameter installations, of 18-inch to 42-inch diameter, a second circulation hose is recommended. This circulation hose should be placed on a separate pump that provides additional water movement through the liner. This second hose should be configured with a partially opened end to force more water out of the perforations while still allowing water output from the end (See Section "Number of Circulation Hoses"). For pipe diameters greater than 42- inch a third and possibly a fourth pump may be needed to ensure that a good movement of flow exists in the curing of the liner. The additional pumps should be a minimum of 6-inch pumps and the discharge should consist of a 6-inch circulation hose. Weighting Lay Flat Hose -- The lay flat hose should be weighted when rehabilitating any pipes 24 inches or larger in diameter. The hose must be weighted to aid circulation inside the liner since the circulation hose will tend to float as a result of the hot water and entrained air in the circulating pumps. Weights should be placed every 12-15 feet. Six-ounce fishing weights or several pieces of large chain link can be tied with the same rope used for splicing the hose. Offset holes punched for attachment of the weights and those placed in the discharge hose for increased water circulation. Insure all sharp edges are removed from the links of chain. Failure to weight the hose may result in poor heating along the invert of the installed liner which could require an extended cure cycle or produce an uncured section of liner. Number of Circulation Hoses -- As the diameter and length of the rehabilitation increases, the need to increase the circulation within the tube becomes a necessity. In general one should consider using two circulation hoses for any tube that is 18 inch in diameter or larger. This can be accomplished by attaching two circulation hoses onto the end of the liner. One hose is then attached to the output water from the heater truck and should have no perforations with the end open to allow all the water to output to the end of the tube. The second lay flat is allowed to have multiple perforations as described previously. However, this second hose should be partially (i.e. 50%) closed at the end in order to force more water out the holes punched along the length of the hose. This second discharge hose is not weighted. This circulation hose should be attached to a separate pump (capable of pumping high temperature water) that is simply pulling the water out of the column and returning it throughout the length of the lining tube. WATER COLUMN CONSTRUCTION Top Ring -- The top ring may be any number of diameters depending on the size and construction of the top ring and cone. The top ring can be constructed of carbon or stainless steel. The outer surface of the top ring must have several protruding beads welded around the full circumference at evenly spaced intervals of approximately 1.5 - 2 inches (38 - 50 mm). The beads should be at least 0.125 inch high and a minimum of three beads per end is recommended. These welded beads are necessary to attach liner such that it can slip off during the installation. All the metal surfaces must be completely smooth and free of burrs or sharp edges that might cut or damage the circulation hose(s) or the liner being inverted. Column Height & Diameter -- Guidance for the lengths can be calculated to give recommended water column height based on the diameter and thickness of the liner to be installed. Variable diameters must be manufactured to accommodate the diameter of the liners installed. For example, a top ring may be constructed with a 7.0 inch diameter at the face where the liner itself is attached. The 7.0-inch face would accommodate the installation of 8-10 inch diameter liners. Allowing the column to be a larger diameter makes room for the suction and circulation hose, as well as a plate mold for sampling purposes. For 12” diameter liners, use a 11” diameter bottom ring. For larger than 12” diameter liners, use the liner itself for the downtube. LINER Handling and Storage -- Always protect the liner from anything that might produce holes in the membrane. This includes walking on the hose, dragging it across the road etc. Holes or weak areas may result in a large tear once the liner is stretched with hydrostatic pressure. Also take note that the liner loses strength and is further weakened with heat from the hot water so damaged areas may not become apparent until fully into the curing cycle. Measurement -- Center of manhole to center of manhole plus 5 feet to ensure the liner never inverts all the way to the end attachment where the holdback rope and lay flat circulation hose are connected. Longer turn-backs result in poor circulation at the downstream end of the cured-in- place pipe and can produce soft ends and/or lifts along the bottom of the liner. End Piece Attachment - “Soft Ends” are purchased from the liner manufacturer and installed on during fabrication of 15” diameter liners and greater. This consists of a handle, constructed of rope covered in tubing and polyurethane, is stitched and adhered on the liner. This will seal the end of the liner. NOTE: The following is a summary of a recommendation by National EnviroTech Group, L.L.C. to use on small diameter liners. The end piece consists of a short piece of 1-2 inch pipe several inches long with caps attached to each end. The end caps on the end pieces should have holes in each end so that any trapped air may be released from the center of the liner as it inverts into the resin saturated tube. Attach a small one way valve to the end piece to allow air to flow out and prevent water from forcing its way back into the center of the installed liner. Place a short section, approximately 2 ft. in length, of rigid hose through the one way valve into the liner. Note: The outside diameter of this hose must be small enough to fit through the one way valve. About 4 - 6 inches of this hose should stick out of the one way valve. If hold-back ropes are tied around the end of the liner, it could possibly cut off the air being released. This section of hose will allow trapped air to be released from the liner in this situation. Alternatively, a piece of heater hose equivalent in length to the standpipe plus five feet may also be attached to an appropriately sized nipple on the end piece. This allows the liner to completely submerge to the bottom of the standpipe forcing air out the heater hose. End Piece Size Recommendations End Piece Diameter Liner Diameter 1.5” 8" - 12" Place the small section of rigid hose in the end piece. The end piece should be centered in the liner, and just slightly inside, such that some liner extends beyond it. Fold the portions of the liner on either side of the end piece in a zigzag serpentine manner and gather it at the nose piece. Place a single wrap of thin felt about 2 inches wide around the area to be banded in the center of the end piece. This will protect the liner from being cut by the banding straps. Band the liner around the end piece with at least two 3/4" stainless steel doubled banding straps for small end pieces and three for larger tubes using larger end pieces. Properly banding the liner is critical in order to prevent water from leaking between the liner and the end piece. Complete the procedure by making several wraps with black electrical tape around the bands and buckles to make sure there are no sharp edges that could damage the liner while the end piece moves through the tube during inversion. Attachment to Top Ring -- Pull the liner through the top ring and/or column making sure that there are no twists. Check for twists by inspecting the location of the seam to insure it goes into and out of the top ring in the same position. If the inversion initially proceeds very slowly then stops and does not proceed any further and it is suspected that the liner may be twisted, pump the water out of the column and liner and remove the liner and start over again. If the liner becomes too large to clearly identify its orientation (i.e. top, bottom, and sides) with respect to the cone, it should be marked before pulling through the top ring. This may be done by numbering the liner 1, 2, 3, 4 starting at the top and proceeding around the tube. Turn the liner back over the face of the top ring ensuring that all folds are evenly spaced around the full circumference. Ensure that the numbers are approximately lined up at the top, bottom, and sides of the face of the cone face. All liners must be attached with a minimum of two 3/4" stainless steel doubled banding straps placed between the grooves of welded beads placed on the surface of the cone. Always protect the liner from the banding straps with 1.5 - 2.0 inch strips of 3 mm felt or liner material placed between the turned back liner and the banding strap. Failure to place the padding under the banding straps and buckle may result in cuts in the liner as the column fills with water and puts pressure against the banding strap. Always place the banding straps between the welded beads ringed around the face of the cone to prevent the liner from slipping off the face of the column. Complete the procedure by wrapping duct tape around the bands and banding buckles. Attachment of Lay Flat and Hold Back Rope -- Always use separate ropes for the hold back and the circulation hose(s). Also ensure that the rope being used is strong enough to withstand the forces that may be exerted on them. For example, just ten feet of water on a 36-inch diameter tube will generate several thousand pounds of force on the hold back rope. Start by using several 0.375-inch nylon ropes tied just behind the end piece. Use two ropes for attachment of the hold back rope and two ropes for attachment to the circulation hose. Duplication of the rope ties provides additional safety in the event any of the knots become detached. If two circulation hoses are used attach this discharge hose in a similar manner. Allow the rope to be long enough such that the hold back rope and circulation hose will be approximately 12 inches behind the end piece. LINER PLACEMENT Off-Loading Tube from Truck -- Pull the tube off the truck manually one fold at a time. If the tube is not pulling easily or is of a size that it is pulling with difficulty, the tube must be unloaded with the use of a winch system or boom truck. High pulling forces placed on the tube may result in unnecessary stretching. End Restraints and Bulk Heading -- Provisions must be made to restrain the end of the resin saturated tube at the downstream manhole and at any intermediate manholes. Failure to restrain the tube may result in unnecessary stretching or rupture of the liner. THERMOCOUPLES Placement -- While inverting the liner, thermocouples must be placed between the resin saturated tube and the host pipe. It is recommended that thermocouples be placed on the top and bottom of the tube at the upstream and downstream manholes, as well as in any intermediate manholes. In addition, a small diameter spike attached to a heater hose that is longer than the depth of the manhole should be pierced into the end of the installed lining tube. This should be placed at the bottom of the liner or as close to the bottom as possible. A thermocouple or twisted thermocouple wire may then be placed into the end of the heater hose. A small stream of installation water from the lining tube is allowed to bleed out of the heater hose, thereby allowing the downstream water temperature in the liner to also be measured during the installation. The tube also allows any trapped air at the end of the liner to be released, which further optimizes the heating and curing process at the end of the tube. Recording Times -- A hand held thermocouple recording device should be used to measure all temperature readings during the curing and cooling procedure. All thermocouple readings and the temperature of the circulating water should be recorded every 15 minutes if possible, but no less than every 30 minutes. All readings monitored with a hand held thermocouple recording device should be recorded on a curing record as a function of time that is a permanent part of the documentation related to the installation. Documentation--All written readings as well as recording charts should be kept together on one sheet that describes specifics of the project, the pipe, its location, and the liner used in the rehabilitation. This cure summary is often required by the client and is helpful for review in the installation of CIPP. LINER INSTALLATION Materials -- Prior to beginning the liner inversion process a lubricant such as vegetable or mineral oil should be added to the column. Only a small amount of oil is necessary to lubricate the liner. Water Filling & Hose Inversion -- Be sure to have a large ball valve on a smooth piece of pipe or hose to add water into the column until the hydrostatic head you require is achieved. Personnel standing next to the column must continuously regulate the water during the installation process. Begin filling the column with water and the liner should begin feeding into the tube. It is essential to maintain the required hydrostatic head continuously during the inversion of the liner. Feeding the Inversion Tower Un-Folding & Feeding-- As the liner is fed into the water column take care to ensure the liner is not twisted at any time. The liner should also be held back with the minimum amount of water head pressure in the column in order to fully inflate the liner. This will also aid pushing any water in the host pipe out and ahead of the liner. As the liner approaches the halfway point of installation, trapped air in this tube may balloon out in this tube. At this point slow and/or stop the inversion to allow the air to evacuate the burp tube. When all of the air has evacuated from the liner, seal the burp tube with a piece of duct tape. If installing a liner with an end piece, a heater hose is used to evacuate air, let the liner disappear into the standpipe and stop the water flow and the installation to allow all the air to evacuate. Before continuing with the installation bend the heater hose over onto itself and tape it securely to prevent water from entering into the liner. Once the liner enters the standpipe, use the hold back rope to restrain the inversion of the liner. Do not pull on the blue discharge hose since it will more easily tear since it does not have the strength of the braided rope. In addition, as the blue circulation hose is being fed into the standpipe, constantly monitor this hose to ensure it also goes into the liner without any twists and that the splices are made in the correct direction. Restrained Sample Ring and Bulk Heading--When the liner is within 10-20 feet (3-6 m) of the end of the pipe, place your sample restraining ring and bulk-head in the downstream manhole. Refer to the "Sampling" section for guidance on proper sample size. After the sample piece is in place and the end properly bulk headed (as necessary) the liner is fully inverted through the restraining ring and up against the bulkhead. Final Filling -- After the liner has been fully installed and bulk heading (if necessary) is complete, fill the column according to the recommended curing head. Ideally, the liner should be filled to the recommended level for maximum hot curing. Allow the liner to expand and fit tightly against the host pipe. However, one must also consider the conditions surrounding the pipe being rehabilitated when determining the final proper initial and curing water head pressures. The standpipe head pressure should be a minimum of 3 psi (6-7 feet of water) greater than that of the known ground water around the pipe or full service lateral pressures. Prior to proceeding with the curing and cool down procedures put the plate molded sample into the standpipe if this method of sampling is being utilized. CURING AND COOL DOWN As the liner is initially heated in the first stage of the curing process, the lining tube will have stretched and the water head may be lowered to where it is between the maximum hot and recommended water column heights. Variable or Staged Cure Strategy -- The temperature and times for curing tubes vary as a function of tube thickness. The purpose is to optimize the water temperature so the resin is cured completely without producing an exotherm so hot to produce damage to the tube. If the resin is allowed to exotherm above 270F (132C) the styrene in the resin will vaporize, producing a liner having a porous, foam-like consistency. This phenomenon is sometimes referred to as "styrene boil." When a liner experiences styrene boil, the properties of the final product may be reduced from that of an optimally cured CIPP. For optimum physical properties and corrosion resistance, it is recommended that the fabric tube be cured under variable conditions based on the thickness of the liner being installed. SAMPLING General -- Considering the various aspects of tube wet out and installation, final CIPP sampling is probably one of the most important procedures of the entire process. Although sampling may seem like a troublesome afterthought to the whole process, it is most important because this is the item by which the installed liner is deemed to be accepted or rejected. Every client specification calls for minimum thickness and physical property requirements for the installed product. The sample taken from the CIPP represents the installed product. If the sample is poorly handled or damaged and the properties measured are substandard, the liner will be rejected on the basis of a poor sample. Sampling and Sample Size -- The following is a summary of recommended sampling procedures. There are basically two accepted methods of obtaining samples from installed CIPP: • A plate molded sample of resin and felt from the installed tube, and • A restrained piece of CIPP cut from the liner itself. In addition to proper sampling, it is critical to obtain enough CIPP to perform the flexural property testing that is typically performed to evaluate the minimum physical requirements. For either type of sampling procedure, the required sample sizes should be in the following range in order to have enough material to evaluate according to ASTM D790. • For 4.5 - 13.5 mm thick CIPP, the sample should be 6 inches wide and 10 inches long. • For 15 - 21 mm thick CIPP, the sample should be 8 inches wide by 15 inches long. • For 22.5 - 28.5 mm thick CIPP, the sample should be 10 inches wide by 24 inches long. FINISHING STEPS • Cutting Ends -- After the liner has been cured and cooled down, cut a window in the cured liner in the downstream manhole. Visually inspect the interior of the liner. If the liner appears unacceptable (soft, fins, etc.), contact the supervisor before proceeding. If the liner is acceptable, each end should be cut approximately 4 inches beyond the pipe face. Allow this outer portion of the liner to protrude into the manhole or pipe access because it helps lock the liner into the pipe face and provides an area for facing the pipe with the specified thermosetting or cementitious grouting material. • Removing Rope and Lay Flat - Once the layflat has been cut from the liner in the downstream manhole, pull the hold back rope and discharge out of the liner through the upstream manhole. • Cutting Laterals -- Enter the pipe with camera and cutting equipment and reinstate the service laterals. • Facing Ends -- Face the ends of the pipe with the specified thermosetting or cementitious grouting material. For optimal resistance to hydrogen sulfide related corrosion, it is recommended to use a polymer-based grout or polymer coating designed for such purposes. • Final Underground CCTV Inspection & Review -- After the laterals have been opened and the ends of the pipe coated or sealed, perform the final CCTV inspection through the entire length of the CIPP. It is recommended that all of the aforementioned finishing steps should be accomplished prior to taking down any by-passed sewerage plugging and pumping. The final inspection should show the full diameter of the CIPP throughout the length of the pipe being inspected. SUGGESTED CURING FOR RESIN USED IN PIPE REHABILITATION A properly designed, fabricated, and installed cured-in-place pipe made with an isopthalic polyester resin or a vinyl ester resin should give satisfactory service in gravity flow sewer systems. VARIABLE CURE STRATEGY: The temperature and times for curing liners are varied as a function of liner thickness. The purpose is to optimize the water temperature so the resin is cured completely without generating too much heat during the polymerization process. If the resin is allowed to exotherm above 270ºF the styrene in the resin will vaporize, producing a liner having increased porosity. This phenomena is sometimes referred to as "styrene boil" because styrene monomer boils at 270ºF. When a liner experiences styrene boil, the properties of the final product may be reduced and/or the liner may have increased porosity. Curing at lower temperatures over longer periods of time produce the highest quality and most consistent cures that can be obtained. THERMOCOUPLE PLACEMENT: It is recommended that thermocouples be placed at both ends of the tube at the top and bottom (i.e. 12 and 6 o'clock positions) of the tube between the liner and the host pipe. Where the tube goes through an intermediate manhole, thermocouple wires should be placed at the top and bottom of the tube between the tube and the host pipe. Additional thermocouples within the layers of the tube are also an option that can be helpful. The purpose of placing thermocouples is to have an indication of how the tube may be curing, as well as a thermal history of the cure at various places on the tube. Thermocouples are also necessary for trouble shooting in case problems occur with the boiler or circulation hoses. Where chart recorders are not being used as a permanent record of the thermal history, hand held thermal recorders should be read and the data recorded with the time every fifteen minutes. In addition to the thermocouples, a sharpened tube should be used to pierce the downstream end of the liner. Attach a heater hose to the end of the tube so that it can be brought up and out of the manhole or piping access. This tube can then be used to bleed water out of the lining tube and the water temperature at the downstream end can be measured. The water temperature at the water heating truck should also be measured at the suction side as well as the output. These water temperatures must also be recorded along with the thermocouples that have been placed between the liner and the existing pipe. RECOMMENDED CURE SCHEDULE For optimum physical properties and corrosion resistance, it is recommended that the cured-in-place pipe tube be cured under variable conditions based on the thickness of the liner being installed. I. Cured-in-place pipe liners 4.5-12.0 mm thick. • Ramp cure these liners to a temperature of 175ºF (+5 to 7ºF) from top to bottom ends of the liner tube. When temperature is stable from top to bottom end of liner tube, start the hold time of the temperature (hold equal temperature of 175ºF (+5 to 7ºF) top to bottom for a minimum of 3 hours for liner lengths of 300 to 350 foot. For liners greater in length add one hour per 100 foot of liner tube. Temperature Equilibrium Note: The temperature difference of the water between the upstream and downstream ends of the tube will vary depending on the size of the pipe, the size of the water heater, the condition and size of the circulation hose, and the capacity of the circulation pumps. Therefore, it is very important to monitor the water temperature on both ends to ensure a proper cure is accomplished. Post Cure Note: If the thermocouples are reading incorrectly, very low (i.e. less than 175ºF), or there is an excessive amount of water running in and around the old pipe, increase the post cure for one additional hour and re-evaluate the thermocouple readings. • Cool down the water slowly from 185ºF to 100ºF at a rate no faster than 30Fº/hr. II. Cured-in-place pipe liners 13.5-16.5 mm thick. • Slowly raise temperature of the return water (i.e. column end) to 145ºF (±5ºF) over the course of 1 hour minimum. The downstream water temperature should be 145ºF (±5ºF). Temperature Equilibrium Note: The temperature difference of the water between the upstream and downstream ends of the tube will vary depending on the size of the pipe, the size of the water heater, the condition and size of the circulation hose, and the capacity of the circulation pumps. Therefore, it is very important to monitor the water temperature on both ends to ensure a proper cure is accomplished. • When the return (i.e. column end) water temperature reaches 145ºF (±5ºF), start raising the water temperature to 175ºF (+5 to 7ºF). • After downstream and column end of the liner tubes water temperature equals 175ºF (±5 to 7ºF), start timing and maintain that temperature for 3 hours minimum. Post Cure Note: If the thermocouples are reading incorrectly, very low (i.e. less than 175ºF), or there is an excessive amount of water running in and around the old pipe, increase the post cure for one additional hour and re-evaluate the thermocouple readings. 5) Cool down the water slowly from 185ºF to 100ºF at a rate no faster than 30ºF/hr. III. Cured-in-place pipe liners 18.0-22.5 mm thickness. • Slowly raise temperature of the return water (i.e. column end) to 145ºF (±5ºF). The downstream water temperature should be 150ºF (±5ºF). Temperature Equilibrium Note: The temperature difference of the water between the upstream and downstream ends of the tube will vary depending on the size of the pipe, the size of the water heater, the condition and size of the circulation hose, and the capacity of the circulation pumps. Therefore, it is very important to monitor the water temperature on both ends to ensure a proper cure is accomplished. • When the return (i.e. column end) water temperature reaches 145ºF (±5ºF), start timing and maintain the temperature for 1 hours minimum. • After 1 hour, increase the downstream water temperature to 175ºF (±5ºF) and the return water temperature to 175ºF (±5ºF) in a minimum of 1 hour. • When the return water temperature reaches 175ºF (±5ºF) start timing and maintain that temperature for 3 hours minimum. Post Cure Note: If the thermocouples are reading incorrectly, very low (i.e. less than 150ºF), or there is an excessive amount of water running in and around the old pipe and the liner, increase the post cure for one additional hour and re- evaluate the thermocouple readings. • Cool down the water slowly from 175ºF to 100ºF at a rate no faster than 25ºF/hr. IV. Cured-In-Place Pipe Liners 24.0-33.0 mm thickness. • Slowly raise temperature of the return water (i.e. column end) to 155ºF (±5ºF) over the course of 2 hours minimum. The downstream water temperature should be 160ºF (±5ºF). Temperature Equilibrium Note: The temperature difference of the water between the upstream and downstream ends of the tube will vary depending on the size of the pipe, the size of the water heater, the condition and size of the circulation hose, and the capacity of the circulation pumps. Therefore, it is very important to monitor the water temperature on both ends to ensure a proper cure is accomplished. • When the return (i.e. column end) water temperature reaches 155ºF (±5F), start timing and maintain the temperature for 4 hours minimum. • After 4 hours, increase the downstream water temperature to 175ºF (±5ºF) and the return water temperature to 175ºF (±5ºF) in a minimum of 1 hour. • When the return water temperature reaches 175ºF (±5ºF), start timing and maintain that temperature for 8 hours minimum. Post Cure Note: If the thermocouples are reading incorrectly, very low (i.e. less than 160ºF), or there is an excessive amount of water running in and around the old pipe, increase the post cure for one additional hour and re-evaluate the thermocouple readings. • Cool down the water slowly from 175ºF to 100ºF at a rate no faster than 20ºF/hr. RECOMMENDED LATERAL REINSTATEMENT PROCEDURES "Lateral Reinstatement" is the process of re-instating service connections of lateral lines connecting to the line segment where CIPP has been installed. This process entails the cutting of the CIPP liner that has covered the service connection during installation. Lateral Reinstatement - Mechanical Initial Preparation. Select and test appropriate cutting tool for the application at hand. Job Site Preparation. Arrive at job site and place cutting van over correct manhole. Set up traffic control according to Traffic Control Plan. Set Bypass according to Bypass Plan.( If it is needed.) Next, set up and power camera and cutter to verify they are in proper working order. Place camera and cutter in line segment. Cutting Laterals. Zero footage counter and start recording. Move camera and cutter to predetermined footage for service to cut. Verify footage with evaluation tape. Adjust cutter to correct clock position for service (ex: 3 o'clock) and cut service. Once the service is cut, fill out "Lateral Reinstatement" form. If the line segment has multiple service connections, continue steps listed above until all services in line segment are cut. Completion. When all services in line segment are cut, remove cutter from line. A Post CCTV inspection is taken of the entire line segment. Clean the job site and submit Completion Notices. Lateral Reinstatement- Man-Entry Note: National Liner personnel shall comply to all local, state and federal regulations pertaining to confined space entry. Cutting service connections on large diameter pipe are done by a man entering the pipe and cutting the tap with pneumatic-powered cutting devices. Initial Preparation. Select appropriate cutting tool for the application at hand. Job Site Preparation. Arrive at job site and place cutting van over correct manhole. Set up traffic control according to Traffic Control Plan. Set Bypass according to Bypass Plan. Next, set up and power camera and cutting equipment and verify they are in proper working order. Test atmosphere of manhole for gasses and oxygen content. Record readings on "Confined Space Entry" form. Start air blower and ventilate manhole. Reinstating Laterals. Zero footage counter and start recording. Using approved safety equipment, a man enters the manhole and moves to predetermined footage for service to cut. Verify footage with evaluation tape. After finding service connection, the service is cut. Document that each live service has been reinstated. If the line segment has multiple service connections, continue steps listed above until all services in line segment are cut. Completion. When all services in line segment are reinstated, remove man and equipment. A Post CCTV inspection is taken of the entire line segment. Perform site restoration per specifications or owner’s requirements. CURED-IN-PLACE PIPE SAMPLING PROCEDURES The following is a summary of recommended cured-in-place pipe (CIPP) sampling procedures. There are two accepted methods of obtaining samples from installed CIPP: 1) a plate molded sample of resin and felt from the installed tube, and 2) a restrained piece of CIPP cut from the liner itself. In addition to proper sampling, it is critical to obtain the required size of sample to perform the flexural property testing that is typically performed to evaluate the minimum physical requirements. For either type of sampling procedure, the required sample sizes should be in the following range in order to have enough material to evaluate: • For 4.5-13.5 mm thick CIPP, the sample should be 6 in. wide and 10 in. long. • For 15-21 mm thick CIPP, the sample should be 8 in. wide by 15 in. long. • For 22.5-28.5 mm thick CIPP, the sample should be 10 in. wide by 24 in. long. PLATE MOLDED SAMPLES The most consistent and highest quality sampling technique is to produce plate molded samples that are placed in the column during the cure process. In general, it becomes extremely difficult to obtain restrained samples from CIPP larger that 18 inch diameter due to the restriction of size of the manhole ring itself. Therefore, plate molded sampling is perhaps the only reliable method for sizes greater than 18 inch diameter. However, this sampling technique can be used for any size or thickness of CIPP. The plates should be 3/16 or 1/4 inch thick aluminum, which is probably the best material because it is light and resists oxidation. Care should be taken in handling the sample plates so that the plates are not scratched on the surface where the wet out liner is to be positioned. Plates fabricated to a size to accommodate the aforementioned dimension ranges. Spacer bars must also be prepared to provide the required thicknesses of the tubes installed. The actual process of preparing plate-molded samples is best accomplished in the following manner: • Select the appropriate size plate for the sample being prepared and coat the inner surface of the plate with a liberal amount of mold release (i.e., PVA). • Prepare a Polyurethane or plastic sleeve that it is the appropriate size for your plate. • Seal three sides of the sleeve. • Prepare two Mylar sheets and place inside the sleeve. • From a piece of well saturated liner that is to be installed, cut out the appropriate size of material based on the thickness of tube installed. For best results, only use saturated felt without any plastic coatings. • Place saturated felt layer(s) into a plastic or polyurethane sleeve, between the two Mylar sheets, and squeeze out all excess air. For best results place the saturated felt at one edge of the sleeve with all the excess on the other side. • Seal the fourth side of the sleeve. • Place the appropriate spacers in the mold forming a trough for the sleeve to be placed into. Prior to placing the sleeve into the mold, roll any excess plastic up on one side so that excess resin in the felt can squeeze into this avail able space. Take care to use the proper spacers for the thickness of liner installed. • Put the second plate in place and tighten down carefully. If it appears that the sleeve may burst due to excess resin, back off and readjust the felt in the sleeve. However, it is critical that the felt layers are compressed tightly between the two plates because any delamination between adjacent layers of felt will severely reduce the physical properties of the sample. • A rope is attached to the plate so it can be lowered into the water column and cured with the same thermal cycle as that of the CIPP. • After curing, remove the CIPP sample from the plate. Take care in the removal of the CIPP as not to damage the CIPP. Excessive force in removal of the CIPP may cause damage to the CIPP sample (cracks, gouges, etc). Samples should be thoroughly inspected for thickness, damage, or any abnormalities before forwarding on to clients and/or testing facilities. If damaged areas exist next to acceptable areas, clearly mark the specimen where it should be tested. NOTE: Do not try to remove the CIPP sample with excessive force (i.e., Throwing CIPP/Plate on the floor). If the CIPP sample will not release from the plate, it is recommended to use a small screwdriver and a hammer. Place the edge of the screwdriver between the CIPP and plate and tap gently until the CIPP sample releases from the plate. Alternately, if it is not possible to cut a portion of saturated felt from the liner, then similar felt may be saturated with the resin used in the installation and this may be placed in the clamped mold assembly. RESTRAINED SAMPLING TECHNIQUE If the client requires a sample cut from the installed liner, the best results are obtained by restraining the CIPP outside the pipe so it can easily be removed for evaluation. Due to the difficulty in restraining larger diameter CIPP (i.e. greater than 18 inches), this technique is limited in its utility for sampling CIPP. Always avoid sampling unrestrained CIPP because the tube may be thinner and lower densities because it often stretches out beyond the diameter of the host pipe and will usually have poorer cure because of no heat retention. If the CIPP cannot be restrained then make provisions to produce a plate molded sample. A restrained CIPP sample is best accomplished in the following manner: • Prepare a piece of thin walled PVC, preferably C-900, of proper diameter and length to accommodate the specified size versus thickness requirements given previously. Coat the inner surface of the PVC pipe with a liberal mold release (i.e., PVA) so the CIPP can easily be removed. • Invert the liner. • Place the PVC pipe over the end of the tube in the downstream manhole as the inverting tube enters the downstream manhole. • After curing, remove the restrained CIPP and cut into three even pieces for testing. When removing the CIPP sample from the PVC, care must be taken not to damage the CIPP sample (See Note below). It is recommended that one is given to the client and the other two are kept for internal evaluation. It is strongly suggested that all samples be thoroughly inspected for thickness, damage, or any abnormalities before forwarding on to clients and/or testing facilities. If damaged areas exist next to acceptable areas clearly mark the specimen where it should be tested. NOTE: Do not try to remove the CIPP sample with excessive force (i.e., Throwing CIPP/Plate on the floor). If the CIPP sample will not release from the plate, it is recommended to use a small screwdriver and a hammer. Place the edge of the screwdriver between the CIPP and plate and tap gently until the CIPP sample releases from the plate. If the engineer requires a restrained sample for diameters greater than 18 inches, PVC pipe can be split along the axis like a clamshell so it can pass through the manhole ring. Once placed around the liner, the two (or more) pieces of PVC can be held together with a ratchet strap or banding. The PVC piping can also be cut along the axis and then held together with hinges, allowing it to open as it passes through the manhole ring. Section II Plan and Equipment Questionnaire 1. See attached Installation Plan 2. Past/current subcontractors a. Structured Solutions i. 814 West Pearl Street, Union City, Indiana 47390 ii. Joshua Price, 800-518-8971 iii. Manhole rehabilitation b. Parrish Excavating, Inc. i. 65 Cole Street, Quincy, MI 49082 ii. Brad Parrish, 517-639-4656 iii. Opencut repairs c. Chicagoland Trenchless Rehabilitation Systems, Inc. i. 7400 Waukegan Rd. Suite #102, Niles IL. 60714 ii. Danny Di Paolo, 773-575-5302 iii. Lateral lining and sectional lining d. ART i. 7400 Waukegan Rd. Suite #102, Niles IL. 60714 ii. Alex Lantz, 419-799-1308 iii. Manhole rehabilitation e. Spectra Tech, LLC i. 15230 Endeavor Dr, Noblesville, IN 46060 ii. Jeff Woodcock, 317-770-0300 iii. Manhole rehabilitation f. Bercot Inc. i. 6015 Huguenard Rd, Fort Wayne, IN 46818 ii. John Bercot, 260-489-4561 iii. Opencut repairs g. Performance Construction Engineering i. 217 W John Street, Plano, IL 60545 ii. Lonnie Avery, (630) 918-1237 iii. Opencut repairs 3. Proposed subcontractor for said project a. Structured Solutions i. 814 West Pearl Street, Union City, Indiana 47390 ii. Joshua Price, 800-518-8971 iii. Manhole rehabilitation Rev.312112024 VEHICLE REGISTRATION / LICENSE Veh Gross locatior Weight Date State Aquired LIC Description Serial # Asset Type Acquirecl Value 248 MN 22,620 Aug-17 Wl 20ITWOLVERINECUTT|NGTRUCK 22,620 Aug-17 Wl 2017 WOLVERINE CUTTING TRUCK 32,000 Nov-17 Wl 18 FTL GROUT TRUCK 32,000 May-19 Wl 2020 FTL GROUT TRUCK lryaclFE?!fi!u68_58 vE HI9LF 3ALACXFEsMDMP6l 1 O VEHICLE 1 FVACXFE4JHJN631S VEHICLE 1FVACXFEgJHJR5367 VEHICLE245 250 1FVACXFE4JHJV7996 VEHICLE 22,620 20,000 May-19 Jul-21 Sep-20 Wl 2021 FTL WOLV 2.0 CUTTER TRUCK ?53 254 WI 2017 F-550 GROUT TRUCK WI 2021 FTt WOLV2.O CUTTING TK 1 FDUF5GTOHED24363 VEHICLE lL 33,000 1 FVACXFE3NHNC3674 VEHICLE 255 32,000 May-22 Wl 2023 FTL M2106 (WOLV. 2.0 CUT TRK)1 FVACXFEGPHUE9346 VEHICLE 32,000 May-22 Wl 2023 FTL M2106 (GROUT TRK)1 FVACXFE4PHUE9345 VEHICLE 21,000 May-O2 MN 01 ISUZU JA1FsC13517701128 VEHTCLE 26,000 Dec-'l0 Wl 09 GMC 5500 TV TRUCK 1GDE5V1969F41O23O VEHICLE May-22 Wl 2023 FTL M2106 (WOLV. 2.0 CUT TRK)1 FVACXFE8PHUE9347 VEHICLE Y.t 2]02!F.l! \4270 (YvoF!1rN llocRFgs)3ALACXFE2RDUS2O2T VEH ICLE 256 257 MN MN258 259 32{90 32,000 Mar-23260 291 301 32,000 8,000 Jan-24 Wl 2016WOLVER|NECUTTERTRUCK Jul17 Wl 2017 F'150 PICKUP MN 6,000 Sep-17 MN ?015 FOle F-150 P|CKUI 6,000 Sep-17 Wl 2017 FORD F-150 PICKUP 8,000 jglJ!_ryL,2!1ElotD F1 50 PICKUP 8,000 8,000 Oct-19 Wl 2019 FORD F150 Oct-19 MN 2019 FORD F150 2NKHH_M7XoGM130331 yEH|CLE 1 FTEX1CF6HKE249O5 VEHICLE 302 1FTEX1EP2FFB81783 VEHICLE 1 FTEWl EF1 HFB4286O VEHICLE 1FTEX1C52JFE16838 VEHICLE 303 JARED S. 304 GREG B 308 309 TONY D MN 1 FTEX1C51 KKFO43O5 VEHICLE 1FTEX1C53KKFO43O6 VEHICLE 78,225 370,902 344,450 94,006 80,385 285,000 78,513 87,386 87,386 57,463 120,267 87,386 94,555 325,000 35,634 34,616 36,843 39,732 39,013 36,904 39,026 39,373 37,052 41,375 43,341 43,341 43,487 51,376 51,376 51,376 310 OH 6,000 Aug-20 OH 2018 FORD F150 XLT 311 PETE B 6,000 Aug-20 Wl 2019 FORD F150 XLT - PETE B 312 TOM STOFFEL 6,000 Sep-20 Wl 2018 FORD F150 - TOM S 313 SHAWN N 6,000 Sep-20 MN 2019 FORD F150 - SHAUN N 314 BRUCEK 6,000 Oct-20 Wl 2019 FORD F150/BRUCE KING 315 SHOP 6,000 Nov-20 Wl 2019 FORD F150 PICKUP 316 MIKE BRIGHT 6,000 Nov-20 Wl 2018 F150 PICKUP/MIKE BRIGHT 1 FTEWI EB2JKDO4134 VEHICLE lFTEW1 EB3KFA89972 VEHICLE 1 FTEW1 EB9JFDO6O66 VEHICLE 1 FTFW1 ES9KFAO'1327 VEHICLE 1FTEXlEP8KKD61416 VEHICLE 1FTFX1E49KKE71563 VEHICLE 1FTEX1EBSJFA52176 VEHICLE 317 CURT 6,000 WI 2019 FORD F150 PICKUP/CURT H 1FTEX1EP9KKD68911 VEHICLE 318 BRIAN B 6,000 WI 2019 FORD F2sO/BRIAN BAUMANN 1 FT ZW 2BT 4KEE1 6428 VEH ICLE 319 MARKS 8,000 Nov-21 wl 2021 FORD F15OiMARK SCHLIEVE 1FTFX1EsXMFDl 1096 VEHICLE 1FTFX1 E51MFD1 1OS7 VEHICLE320 LUIS L 8,000 Nov-21 Wl 2021 FORD F150/LUIS LOPEZ 321 ARRONS 8,000 Nov-21 Wl 2021 FORD F150 PU/ARRON 1FTEX1EP3LFB73591 VEHICLE 322 PETEM 8,000 Mar-23 Wl 2023 FORD F150 PU/PETE M 1FTFX1E56PKD45368 VEHICLE 323 JOSEV 8,000 Mar-23 Wl 2023 FORD F150 PU/JOSE V 1 FTFX1 E52PKD455OO VEHICLE 324 JOSH R 8,000 Mar-23 Wl 2023 FORD F150 PU/JOSH R 1FTFX1E57PKD457O4 VEHICLE Rev.312112024 VEHICLE REGISTRATION / LICENSE Veh locatior Gross Asset Type Acquired Value Date State Aquired LIC Description Serial # 386 8,000 Oct-13 Wl 13 FORD F150 PU OH 8,000 Oct-13 Wl 13 FORD F150 PU MN 8,000 Aug-14 MN 14 FORD F150 PU/ MO 8,000 Aug-14 MO 2014 FORD F150 PICKUP lA 8,000 Aug-14 lA 14 FORD F150 PU/ 1FTFX1CF3DKF99322 VEHICLE 1 FTFXI CF5DKF99323 VEHICLE387 389 389 1FTFX1CF8EKE9B472 VEHICLE 390 ,I FTFX1CFXEKE98473 1 FTFX1CF1EKE98474 VEHICLE VEHICLE 391 10,000 Aug-14 Wl 15 FORD F-250 PICKUP 1FT7X2A65FEBO7470 VEHICLE 31,570 31,570 32,465 32,465 32,465 35,025 36,031 36,031 36,103 38,139 38,139 32,310 35,634 35,634 33,144 2,735 3,580 3,580 2,735 24,500 45,456 984 21,000 51,885 41,349 34,456 65,477 25,862 15,465 2,510 5,730 23,373 43,050 392 MO 8,000 Sep-15 Wl 15 FORD F150 PU WI 15 FORD F15O PU 1FTEX1CF8FKE18469 VEHICLE 1FTEXlCF4FKE1847O VEHICLE393oH -81900MO 8,000 8,9oo 8,000 s99115 Sep-16qe4 395 396 wt 20'16 F-150 PICKUP 1FTEX1CF6GFDOO673 VEHICLE OH wt 2016 F-150 PICKUP wt 2016 F-150 PIGKUP/JOSE V MN 3,000 Oct-16 Wl 2016 FORD F 250 PICKUP 8,000 Jul-17 Wl 2017 F150 PICKUP Jul:17 Jul-88 WI 2017 F150 PICKUP/MIKE FRAILING WI INTERSTATE TRAILER Sep-15 Wl 2016 FALCON TMILER Sep-16 Sep-16 1FTEX1CF8GFDOO674 VEHICLE 1 FTEX1 CFXGFDOO6T5 VEHICLE 397 1FT7X2B67GEC1 6366 VEHICLE ,I FTEX1CF2HKE249O3 VEHICLE ,I FTEX1 CF4HKE24SO4 VEHICLE 1 UK500E28K1004080 rl4ll!x TRAILER432SA1011G1001061 398 3gg 409 407 409 8,000 6,999 8,000 8,000 Dec-18 Wl 2018 FALCON TMILER-EASEMENT 8,000 Dec-18 Wl 2018 FALCON TMILER-EASEMENT 8,000 Sep-15 wi zots ioLcoN TRATLER 8,000 Feb-11 Wl 2009 EXTENDAJET W TMILER 432SA1015J1003936 r"l4llE! rRAflER TRAILER TRAILER 4'to 432SA1017J1093937 432sA191xcl9qry69 SFLRPI 01 798003003 411 412 413 8,000 Dec-15 Wl 2016 FALCON TMILER 132!11 91q9l0_01099- rl llEf_ 432SA121381000306 TRAILER4202,995 Oct-13 Wl 11 FALCON TRAILER 422 26,000 Jul-21 Wl 2004 STRONG SEAL SUPPORT TK 1 FVACWDCXsHVO52TC TRUCK 423 8,000 Jul-92 Wl 92 STRONG SEAL TRLR 35D 21117 TRAILER 1 GDE5C1245F525247 VEHICLE42426,000 Aug-05 Wl 05 GMC 5000 MED D 426 26,000 Dec-11 Wl 06 FTL M260 1 FVACWCS66HW81 69. VEHICLE 430 8,500 Apr-12 Wl 11 STRONG SEAL TRAILER MOD 35D 1S9BA22D3BP616004 TMILER 434 6,000 Feb-96 Wl STRONG SEAL TMILER MOD 35C MN 17,600 DCC-14 MN WELLS CARGO TRAILER 18501 TRAILER 575200G24FH286333 TRAItER LCAUSO413NT236664 TRAILER 436 437 MN 1,500 OCt-92 MN 92 TRAILER MN 439 8,000 Feb-l1 Wl ROYALCARGOTRAILER sLABE2O2OBM11O25O TMILER 440 Dec-19 Wl STRONG SEAL MULTI-MATE 22-441 TRAILER 442 8,000 D€c-20 Wl 2020 EXCLOSED TRAILER 7H8212024M1AU224 TRAILER 445 WI RAVEN TRAILER 5WKGE282XM1067684 TMILER 501 Jan-24 Wl 2016 QUAD AXLE LOW BOY TRAILER 5MC145312G5156841 TRAILER Rev.3121t2024 VEHICLE REGISTRATION / LICENSE Veh Gross locatior Weight Date State Aquired LIC Description Serial # Asset Type Acquired Value 514 545 546 54,000 May-07 Wl FTL TS-300 MN 54,000 4qglYv] !t FIl!1112 Nov-07 Wl 08 FTL M2-10654,000 54,000 Nov-07 Wl 08 FTL M2-106 1FVHCYDJ87HY94955 VEHICLE 1 FVHC5CV48HZ61281 VEHICLE 547 1 FVHCYBS38DAB3243 VEHICLE 1 FVHCYBS58DAB3244 VEHICLE lL 32,000 Feb-08 Wl 08 FTL M2-106 1FVACXDJO8DAB5631 VEHICLE519 550 32,OOO MAr.O8 WI 04 PETERBUILT 330 - SUPPT TRK 2NPNHD6X14M812855 VEHICLE 552 26,000 Oct09 Wl 04 FTL 1 FVACWDC44HNO946O VEHICLE s53 26,000 Oct-09 WI 1O FTL STEAMER TRK 1 FVHCYBS3ADAT2gs2 VEHICLE 1 FVACXDCX5HU4S1 85 VEHICLE55432,000 Nov-10 Wl 05 FTL M2 555 54,000 Mar-11 wl 12FTLM2112 1 FVHCSDV4CHBDl 812 VEHICLE 3HAMSMR1CL45O631 VEHICLE55654,000 Mar-11 Wl 12 INTL 4400 557 54,000 Mar-1 1 Wl 12 INTL 4400 9 !4V q44ry914! 0-99-? YEHE LI 1 FVHCYBS2CHBT2195 VEHICLE558s0,000 Dec-1 1 Wl 12 FTL M2-106 559 32,000 May-12 Wl 08 INTL SUPPT TRK 1 HTMMMN58H564961 VEHICLE 1 FVHCYBS4DHFA4O49 VEHICLE56054,000 Sep-12 Wl 13 FTL M2-106 561 54,000 Sep-12 Wl 13 FTL M2-106 1 FVHCYBSODHFA4OSO VEHICLE 562 s4,000 Apr-13 Wl 14 INT'L 7400 REFER 1 HTWGAAR2EH51 5327 VEHICLE 119,918 294,884 128,775 128,775 200,739 42,164 23,774 269,814 22j41 372,499 1s5,276 140,577 94,724 33,833 135,437 144,602 137,147 137,484 319,283 42,538 144,216 143,969 342,814 239,760 97,980 97,980 464,212 107,971 52,O25 151,628 152,302 341,988 136,972 51,302 121,O92 593 564 54,000 Apr-13 Wl 14 INT'L 7400 REFER 50,000 Apr-13 Wl 14 FTL M280 STEAMER ,111{9$t€H9f!?rv_E1-ctE 1 FVHCYCY4EHFL954O VEHICLE 565 OH 32,000 Aug-13 Wl 10 INTL SUPPORT TRUCK 1 HTMMAAN5AH276279 VEHICLE 566 54,000 Mar-'14 Wl 15 FTL M2-160 REEFER 1 FVHCYCY4FHGA2360 VEHICLE 567 54,000 Mar-14 Wl 15 FTL M2-106 REEFER MN 50,000 Mar-14 Wl 15 FTL M280 STEAMER OH 54,000 Dec-15 Wl 16 FREIGHTLINER STEAMER 54,000 Dec-l5 wl 16 FTL M280 REEFER 54,000 Dec-15 Wl 16 FTL M280 REEFER 1 FVHCYCY6FHGA2361 VEHICLE 1 FVHCYCYXFHGA2394 VEHICLE 1 FVHCYCYl GHHD9O2€ VEHICLE 568 569 574 68,000 May-16 Wl 1 7 M2 112 FTL BOILER TRUCK 1 FVHCYCYgGHHM941, VEHICLE 1 FVHCYCYOGHHM94Ii VEHICLE 1 FVHCsDVsHHHY5312 VEHICLE 571 572 573 62,000 Nov-17 Wl 18 FH M2 VAPOR POWER STEAMER 1 FVHCYFElJHJN6499 VEHICLE 574 38,000 Mar-18 Wl 2012 FREIGHTLINER M2 SUPPORT 1 FVACXBSgCHBM5599 VEHICLE 575 54,000 Jun-18 Wl 2018 FTL M2 REEFER 1 FVHCYFEgKHKG6S1 9 VEHICLE 576 54,000 Jun-18 Wl 2018 FTL M2 REEFER 62,000 Nov-l9 Wl 2016 KENWORTH T470-VAPOR POWER 1 FVHCYFESKHKG652O VEHICLE 1 NKBLJOX4GR1018O8 VEHICLE577 578 62,000 Sep-19 Wl 2O2OFTLM280VAPOR POWER 1 FVHCYFE2LHKYs5gs VEHICLE 1 FVACXBSoBDAUSOT4 VEHICLE57938,000 Oct-18 VA 2011 FTLM270 580 68,000 Jan-21 Wl 2021 FTL 1145D BOILER TRUCK 1 FVHG3FM4MHMU43OI VEHICLE G bakertitty I ndependent Auditors' Report To the Members and Board of Directors of Visu-Sewer Group Holdings, LLC Opinion We have audited the consolidated financialstatements of Visu-Sewer Group Holdings, LLC (the Company), which comprise the consolidated balance sheet as of December 31,2023, and the related consolidated statements of operations, members' equity and cash flows for the year ended December 31 ,2023 and the related notes to the consolidated financial statements. ln our opinion, the accompanying consolidated financial statements present fairly, in all material respects, the financial position of the Company as of December 31,2023 and the results of its operations and its cash flows for the year ended December 31,2023 in accordance with accounting principles generally accepted in the United States of America (GAAP). Basis for Opinion We conducted our audit in accordance with auditing standards generally accepted in the United States of America (GAAS). Our responsibilities under those standards are further described in the Auditors' Responsibilities for the Audit of the Consolidated Financial Statements section of our report. We are required to be independent of the Company and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements relating to our audit. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Responsibilities of Management for the Consolidated Financial Statements Management is responsible for the preparation and fair presentation of the consolidated financial statements in accordance with GAAP, and for the design, implementation and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement, whether due to fraud or error. ln preparing the consolidated financial statements, management is required to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about the Company's ability to continue as a going concern within one year after the date that the financial statements are available to be issued. Auditors' Responsibilities for the Audit of the Gonsolidated Financial Statements Our objectives are to obtain reasonable assurance about whether the consolidated financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditors' report that includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with GAAS will always detect a material misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations or the override of internal control. Misstatements are considered material if there is a substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a reasonable user based on the consolidated financial statements. Baker Tilly US, LLP, trading as Baker Tilly, is a member of the global network of Baker Tilly lnternational Ltd., the members of which are separate and independent legal entities. @ 2020-2022 Baker Tilly US, LLP 1 ln performing an audit in accordance with GAAS, we: Exercise professional judgment and maintain professional skepticism throughout the audit. ldentify and assess the risks of material misstatement of the consolidated financial statements, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Such procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the consolidated financial statements. a a Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Company's internal control. Accordingly, no such opinion is expressed. Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the consolidated fi nancial statements. Conclude whether, in our judgment, there are conditions or events, considered in the aggregate, that raise substantial doubt about the Company's ability to continue as a going concern for a reasonable period of time. We are required to communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit, significant audit findings, and certain internal control-related matters that we identified during the audit. a a a 6/*nT,-/h a4 LLf Milwaukee, Wisconsin May 24,2024 2 ll/hen the prospective Contactor is unable lo certify to any of the stutemenls below, it shall attach an explanation to this Allidavit CONTRACTOR'S NON-COLLUSION AND NON-DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids, Please type or print) STATE 6p wisconsin Waukesha COUNTY The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of pelury that: 1, Contractor has not, nor has any other member, representative, or agent ofthe firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor fufther says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2, Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in lran, a. For purposes of this Certification, "lran" means the government of lran and any agency or instrumentality of lran, or as otherwise defined at lnd. Code S 5-22-16.5-5, as amended from time-to-time. b. As provided by lnd, Code S 5-22-16.5-8, as amended from time-to-time, a Contractor is engaged in investment activities in lran if either; i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20.000,000) or more in value in the energy sector of lran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in lran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the lndiana Department of Administration. SS Version 611112024 Contractor's Bid for Public Works - 5 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subscquently learns is an unauthorized alien. Contractor agrees that helshe/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by l.C 22-5-1,7-3. Contractor's documentation of enrollmentand participation in the E-Verify Program is included and attached as partof this bidlquote; and See Attached 5 Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, firms, partnerships, corporations, associations, orjoint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of contract or employment. or any matter directly or indirectly related to contracting or ernployment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age or disability that does not affect that person's ability to perform the work. ln awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions will consider the Contractor's good faith efforts to obtain participation by those subcontractors certified by the State of lndiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal-eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, lndiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry, Breach of this provision may be regarded as material breach of contract. l, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (1.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this prQject if awarded, I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel proclucts or foundry Version 611112024 Contractor's Bid for Public Works - 6 products made in the United States, I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable, I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm under the penalties of peryury that the facts and information contained in the foregoing bid for public works are true and correct. Dared this 9th day of Julv ,20L4 Visu-Sewer LLC Contractor/Bidder (Firm) Signature of Contractor/Bidder or lts Agent Keith M. Alexander PresidenUCEO Printed Name and Title Subscribed and sworn to before me this 9th day Ju 2024 My Commission Expires 2t21t2027 Notary Public,E County of Residence M '$o R v" -lD- =--o';. Fgg;\G ..-_+S a+tr,HiN Version 611112024 Contractor's Bid for Public Works - 7 Ellerify ffi@ €.VERIFY ISA S€RVICE OE OgSAf,D 5SA Company lD Number: 1rc270 THE E.VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS ARTICLE I PURPOSEANDAUTHORITY The parties to this agreement are the Department of Homeland Security (DHS) and VISU'SEWER, lNC. (Emptoyer). The purpose of this agreement is to set forth terms and conditions which the Employer wi[[ follow while participating in E-VerifY. E-Verify is a program that electronicatty confirms an employee's eligibility to work in the United States after completion of Form l-9, Employment EtigibilityVerification (Form l-9). This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the Social Security Administration (SSA), and DHS. Authority for the E-Verify program is found in Title lV, Subtitle A, of the lllegaI lmmigration Reform and lmmigrant Responsibility Act of 1996 (llRlRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. 5 1.324a note). The FederalAcquisition Regulation (FAR) Subpart22.LS,"Employment EtigibitityVerification" and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E-Verify to verify the emptoyment etigibility of certain employees working on Federal contracts. ARTICLE II RESPONSIBILITIES A. RESPONSIBILITIESOFTH E EMPLOYER 1. The Employer agrees to disptay the foltowing notices supplied by DHS in a prominent place that is clearty visibte to prospective employees and al[ emptoyees who are to be verified through the system: a. Notice of E-Verify Participation b. Notice of Right to Work 2. The Emptoyer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives' contact information changes. 3. The Employer agrees to grant E-Verify access only to current employees who need E-Verify access. Employers must promptly terminate an employee's E-Verify access if the employer is separated from the company or no longer needs access to E-Verify. Page 1of 17 E-Verify MOU for Employers lRevision Date 06/01/13 .E-l/erify ffi@ Company lD Number: ,t1g71o 4. The Employer agrees to become familiar with and comply with the most recent version of the E-Verify User Manua[. 5. The Employer agrees that any Employer Representative who will create E-Verify cases wi[[ complete the E-Verify TutoriaI before that individuaI creates any cases. a. The Employer agrees that a[[ Employer representatives willtake the refresher tutorials when prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutoriat witl prevent the Employer Representative from continued use of E-Verify. 6. The Employer agrees to comply with current Form l-9 procedures, with two exceptions: a' lf an employee presents a "List B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. 5274a.2(b)(I)(B)) can be presented during the Form l-9 process to establish identity.) lf an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218. b. lf an employee presents a DHS Form l-551 (Permanent Resident Card), Form l-766 (Employment Authorization Document), or U.S. Passport or Passport Card to comptete Form l-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee's Form l-9. The Employer wi[[ use the photocopy to verify the photo and to assist DHS with its review of photo mismatches that employees contest. DHS may in the future designate other documents that activate the photo screening tool. Note: Subject only to the exceptions noted previously in this paragraph, employees stilt retain the right to present any List A, or List B and List c, document(s) to complete the Form l-9. 7' The Employer agrees to record the case verification number on the employee's Form l-9 or to print the screen containing the case verification number and attach it to the employee's Form l-9. 8' The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to complete, retain, and make available for inspection Forms l-9 that relate to its employees, or from other requirements of applicable regulations or [aws, including the obtigation to comply with the anti- discrimination requirements of sectio n 2748 of the INA with respect to Form l-9 procedures. a. The following modified requirements are the only exceptions to an Employer's obtigation to not employ unauthorized workers and comply with the anti-discrimination provision of the INA: (1) List B identity documents must have photos, as described in paragraph 6 above; (2) When an Employer confirms the identity and employment eligibility of newty hired emptoyee using E-Verify procedures, the Employer establishes a rebuttable presumption that it has not violated section 27aA(a)(1)(A) of the lmmigration and Nationality Act (lNA) with respect to the hiring of that employee; (3) tf the Employer receives a finaI nonconfirmation for an employee, but continues to employ that person, the Employer must notify DHS and the Employer is subject to a civil money penatty between SSSo and S1,t00 for each failure to notify DHS of continued employment foltowing a final nonconfirmation; (4) lf the Emptoyer continues to employ an employee after receiving a finat nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingty Page 2 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 Etlerify ffi@ Company lD Number: 113770 employed an unauthorized alien in violation of section 27aA(a)(1)(A); and (5) no E-Verify participant is civilly or criminally liable under any law for any action taken in good faith based on information provided through the E-Verify. b. DHS reserves the right to conduct Form l-9 compliance inspections, as well as any other enforcement or compliance activity authorized by law, including site visits, to ensure proper use of E-Verify. 9. The Employer is strictly prohibited from creating an E-Verify case before the employee has been hired, meaning that a firm offer of employment was extended and accepted and Form l-9 was completed. The Employer agrees to create an E-Verify case for new employees within three Employer business days after each employee has been hired (after both Sections l and 2 of Form l-9 have been completed), and to complete as many steps of the E-Verify process as are necessary according to the E-Verify User Manual. lf E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Employer's attempting, in good faith, to make inquiries during the period of unavailability. 10. The Employer agrees not to use E-Verify for pre-employment screening of job applicants, in support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User Manual does not authorize. 11. TheEmployermustuseE-Verifyforallnewemployees. TheEmployerwillnotverifyselectivelyandwill not verify employees hired before the effective date of this MOU. Emptoyers who are Federal contractors may qualify for exceptions to this requirement as described in Article ll.B of this MOU. 12. The Employer agrees to follow appropriate procedures (see Article lll below) regarding tentative nonconfirmations. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer agrees to provide both the English and the translated notice and letterfor employees with limited English proficiency to employees. The Employer agrees to provide written referraI instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is stilI pending. Further, when emptoyees contest a tentative nonconfirmation based upon a photo mismatch, the Employer must take additionalsteps (see Articte lll.B. below) to contact DHS with information necessary to resolve the chaltenge. 13. The Employer agrees not to take any adverse action against an employee based upon the employee's perceived employment etigibitity status while SSA or DHS is processing the verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. 5 27aa.1(l)) that the emptoyee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, a case in continuance (indicating the need for additional time for the government to resolve a case), or the finding of a photo mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work authorized. ln any of such cases, the employee must be provided a full and fair opportunity to contest the finding, and if he or she does so, the employee may not be terminated or suffer any adverse employment consequences based upon the employee's perceived employment etigibitity status Page 3 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 .E-llerify ffi@ E,VERIFY IS A SERVI'f, OF'HSAilD 55A Cornpany lD Number: 113770 (including denying, reducing, or extending work hours, detaying or preventing training, requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has been issued. lf the employee does not choose to contest a tentative nonconfirmation or a photo mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the Emptoyer can find the employee is not work authorized and terminate the employee's employment. Employers or employees with questions about a finaI nonconfirmation may call E-Verify at ].-888-464-4218 (customer service) or L-888-897-7781 (worker hotline). 14. The Employer agrees to comply with Title Vll of the Civil Rights Act of 1964 and section 2748 of the INA as applicable by not discriminating unlawfully against any individuaI in hiring, firing, employment etigibitity verification, or recruitment or referral practices because of his or her nationaI origin or citizenship status, or by committing discriminatory documentary practices. The Employer understands that such ittegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound "foreign" or have received tentative nonconfirmations. The Employer further understands that any violation of the immigration-related unfair employment practices provisions in section 2748 of the INA could subject the Employer to civiI penalties, back pay awards, and other sanctions, and violations of Title Vll could subject the Emptoyer to back pay awards, compensatory and punitive damages. Violations of either section 274B of the INA or Title Vll may also lead to the termination of its participation in E-Verify. lf the Employer has any questions relating to the anti-discrimination provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD). 15. The Emptoyer agrees that it will use the information it receives from E-Verify only to confirm the employment eligibitity of employees as authorized by this MOU. The Employer agrees that it willsafeguard this information, and means of access to it (such as PINS and passwords), to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person otherthan employees of the Employerwho are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 16. The Employer agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access to E-Verify personaI data. Allsuspected or confirmed breaches should be reported by calting L-888-464-4218 or via email at E-Verifv@uscis.dhs.gov. Ptease use "Privacy lncident - Password" in the subject [ine of your email when sending a breach report to E-Verify. 17. The Emptoyer acknowledges that the information it receives from SSA is governed by the Privacy Act (5 U.S.C. 5 552a(i)(r) and (3)) and the SociaI Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties. 18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, which includes permitting DHS, SsA, their contractors and other agents, upon Page 4 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 'E-lterify ffi@ E-VERIFY ISA 5ERVIC! OF OhSAND S5A Company lD Number: 113770 reasonable notice, to review Forms l-9 and other employment records and to interview it and its employees regarding the Employer's use of E-Verify, and to respond in a prompt and accurate manner to DHS requests for information relating to their participation in E-Verify. 19. The Employer sha[[ not make any false or unauthorized claims or references about its participation in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its services as federally-approved, federally-certified, or federally-recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false. 20. The Employer shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS. 21. The Employer agrees that E-Verifv trademarks and logos may be used only under license by DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not be used in any manner that might impty that the Employer's services, products, websites, or pubtications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verifi7. 22. The Employer understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU. B. RESPONSIBILITIES OF FEDERAL CONTRACTORS 1. lf the Employer is a FederaI contractor with the FAR E-Verify clause subject to the employment verification terms in Subpart 22.18 of the FAR, it wil[ become familiar with and comply with the most current version of the E-Verify User Manualfor FederaI Contractors as well as the E-Verifu SupplementaI Guide for Federal Contractors. 2. ln addition to the responsibilities of every employer outlined in this MOU, the Employer understands that if it is a FederaI contractor subject to the employment verification terms in Subpart 22.18 of the FAR it must verify the employment eligibitity of any "employee assigned to the contract" (as defined in FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer may not create a second case for the employee through E-Verify. a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract award must enrotl as a Federal contractor in the E-Verify program within 30 calendar days of contract award and, within 90 days of enrollment, begin to verify employment etigibility of new hires using E-Verify. The Employer must verify those emptoyees who are working in the United States, whether or not they are assigned to the contract. Once the Employer begins verifying new hires, such verification of new hires must be initiated within three business days after the hire date. Once enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees assigned to the contract within 90 calendar days after the date of enrotlment or within 30 days of an employee's assignment to the contract, whichever date is later. Page 5 of 17 E-Verify MOU for Emptoyers I Revision Date 06/01/13 :F-lterify ffi@ E-VaAlfl rsA 5ERVICE OF OASAND SSA Company lD Number: rg77o b. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award must use E-Verify to begin verification of emptoyment etigibitity for new hires of the Employer who are working in the United States, whether or not assigned to the contract, within three business days after the date of hire. lf the Employer is enro[[ed in E-Verify as a Federal contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are working in the United States, whether or not assigned to the contract. Such verification of new hires must be initiated within three business days after the date of hire. An Employer enrolled as a FederaI contractor in E-Verify must begin verification of each employee assigned to the contract within 90 calendar days after date of contract award or within 30 days after assignment to the contract, whichever is later. c. FederaI contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)), state or locaI governments, governments of Federally recognized lndian tribes, or sureties performing under a takeover agreement entered into with a Federal agency under a performance bond may choose to only verify new and existing employees assigned to the FederaI contract. Such FederaI contractors may, however, elect to verify a[[ new hires, and/or atlexisting emptoyees hired after November 6, 1986. Emptoyers in this category must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. d. Upon enrollment, Employers who are FederaI contractors may elect to verify employment eligibility of a[[ existing employees working in the United States who were hired after November 6, 1986, instead of verifying only those employees assigned to a covered FederaI contract. After enrollment, Employers must elect to verify existing staff fotlowing DHS procedures and begin E-Verify verification of alI existing employees within 180 days after the election. e. The Employer may use a previousty compteted Form l-9 as the basis for creating an E-Verify case for an employee assigned to a contract as long as: i. That Form l-9 is complete (including the SSN) and complies with Articte ll.A.6, ii. The employee's work authorization has not expired, and iii. The Employer has reviewed the Form l-9 information either in person or in communications with the employee to ensure that the employee's Section 1, Form l-9 attestation has not changed (including, but not limited to, a lawfuI permanent resident alien having become a naturalized U.S. citizen). f. The Employer shall complete a new Form l-9 consistent with Articte ll.4.6 or update the previous Form l-9 to provide the necessary information if: i. The Employer cannot determine that Form l-9 complies with Article ll.A.6, ii. The employee's basis for work authorization as attested in Section t has expired or changed, or iii. The Form l-9 contains no SSN or is otherwise incomplete. Notc: lf Section L of Fornr l-9 is otherwise valid arrd up-to-date and the form otherwise complies wlth Page 6 of 17 E-Verify MOU for Emptoyers I Revision Date 06/01/13 Ellerify ffi@ E"VENIFYISA SENVICE Of DHSAND S5A Company lD Number: irc77o Articte ll.C.5, but reflects documentation (such as a U.S. passport or Form l-551) that expired after completing Form l-9, the Employer shall not require the production of additional documentation, or use the photo screening tooldescribed in Article ll.A.5, subject to any additional or superseding instructions that may be provided on this subject in the E-Verify User Manual. g. The Emptoyer agrees not to require a second verification using E-Verify of any assigned employee who has previously been verified as a newly hired employee under this MOU or to authorize verification of any existing employee by any Employer that is not a Federal contractor based on this Article. 3. The Emptoyer understands that if it is a Federal contractor, its compliance with this MOU is a performance requirement under the terms of the Federal contract or subcontract, and the Employer consents to the release of information relating to compliance with its verification responsibilities under this MOU to contracting officers or other officials authorized to review the Employer's compliance with Federal contracting requirements. C. RESPONSIBILITIES OF SSA L. SSA agrees to a[[ow DHS to compare data provided by the Employer against SSA's database. SSA sends DHS confirmation that the data sent either matches or does not match the information in SSA's database. 2. SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA also agrees to limit access to such information, as is appropriate by law, to individuals responsible for the verification of SociaI Security numbers or responsible for evaluation of E-Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. S 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401). 3. SSA agrees to provide case results from its database within three Federal Government work days of the initiat inquiry. E-Verify provides the information to the Employer. 4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative nonconfirmation visits an SSA field office and provides the required evidence. lf the employee visits an SSA fietd office within the eight FederaI Government work days from the date of referralto SSA, SSA agrees to update SSA records, if appropriate, within the eight-day period unless SSA determines that more than eight days may be necessary. ln such cases, SSA will provide additional instructions to the employee. lf the employee does not visit SSA in the time allowed, E-Verify may provide a finaI nonconfirmation to the employer. Note: lf an Employer experiences technicaI probtems, or has a policy question, the employer should contact E-Verify at 1-888-464 -42L8. D. RESPONSIBILITIES OF DHS 1. DHS agrees to provide the Emptoyer with selected data from DHS databases to enable the Employer to conduct, to the extent authorized by this MOU: a. Automated verification checks on alien employees by electronic means, and Page 7 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 .Fllerify ffi@ E-V€RIFYISA SEiVICE OFDH5AffO SSA Company lD Number: fig17o b. Photo verification checks (when available) on employees. 2. DHS agrees to assist the Employer with operationaI problems associated with the Employer's participation in E-Verify. DHS agrees to provide the Emptoyer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. 3. DHS agrees to provide to the Employer with access to E-Verify training materials as we[[ as an E-Verify User Manualthat contain instructions on E-Verify policies, procedures, and requirements for both SSA and DHS, including restrictions on the use of E-Verify. 4. DHS agrees to train Employers on al[ important changes made to E-Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials. 5. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti-discrimination notices issued by the Office of Speciat Counselfor lmmigration-Related Unfair Employment Practices (OSC), Civit Rights Division, U.S. Department of Justice. 6. DHS agrees to issue each of the Employer's E-Verify users a unique user identification number and password that permits them to log in to E-Verify. 7. DHS agrees to safeguard the information the Employer provides, and to limit access to such information to individuals responsible for the verification process, for evaluation of E-Verify, or to such other persons or entities as may be authorized by appticable law. lnformation witt be used only to verify the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal crimina[ [aws, and to administer Federal contracting requirements. 8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA verification procedures) confirmation or tentative nonconfirmation of employees' employment etigibility within three FederaI Government work days of the initial inquiry. 9. DHS agrees to provide a means of secondary verification (including updating DHS records) for employees who contest DHS tentative nonconfirmations and photo mismatch tentative nonconfirmations. This provides finaI confirmation or nonconfirmation of the employees' employment etigibitity within 10 Federal Government work days of the date of referralto DHS, unless DHS determines that more than 10 days may be necessary. ln such cases, DHS wilt provide additionalverification instructions. ARTICLEIII REFE RRALOF I N D IVI DUALSTOSSAAN D DHS A. REFERRALTOSSA L. lf the Emptoyer receives a tentative nonconfirmation issued by SSA, the Emptoyer must print the notice as directed by E-Verify. The Employer must promptty notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. Page B of 17 E-Verify MOU for Employers I Revision Date O6101/13 El/erify ffi@ Company lD Number: 1lre770 The Employer also agrees to provide both the English and the translated notice and letter for employees with [imited Engtish proficiency to employees. The Employer agrees to provide written referraI instructions to em ployees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is sti[[ pending. 2. The Employer agrees to obtain the employee's response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. After a tentative nonconfirmation, the Emptoyer witl refer employees to SSA field offices only as directed by E-Verify. The Employer must record the case verification number, review the employee information submitted to E-Verify to identify any errors, and find out whether the employee contests the tentative nonconfirmation. The Employer willtransmit the Social Security number, or any other corrected emptoyee information that SSA requests, to SSA for verification again if this review indicates a need to do so. 4. The Employer wi[[ instruct the employee to visit an SSA office within eight FederaI Government work days. SSA witt electronically transmit the result of the referralto the Emptoyer within 10 FederaI Government work days of the referral unless it determines that more than L0 days is necessary. 5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. 6. The Employer agrees not to ask the employee to obtain a printout from the SociaI Security Administration number database (the Numident) or other written verification of the SSN from the SSA. B. REFERRAL TO DHS 1. lf the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer also agrees to provide both the English and the transtated notice and letter for employees with limited Engtish proficiency to employees. The Employer must a[[ow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is stilt pending. 2. The Employer agrees to obtain the employee's response about whether he or she wi[[ contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Onty the employee may determine whether he or she will contest the tentative nonconfirmation. 3. The Employer agrees to refer individuals to DHS only when the emptoyee chooses to contest a tentative nonconfirmation. 4. lf the employee contests a tentative nonconfirmation issued by DHS, the Employer wi[[ instruct the Page 9 of 17 E-Verify MOU for Emptoyers I Revision Date 06/01/13 .,E-lferify ffi@ Company lD Number: f3770 employee to contact DHS through its tolt-free hotline (as found on the referra[ letter) within eight Federal Government work days. 5. lf the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph I of this section for tentative nonconfirmations, generalty. 6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo mismatch, the Employer wit[ send a copy of the emptoyee's Form l-551, Form l-766, U.S. Passport, or passport card to DHS for review by: a. Scanning and uploading the document, or b. Sending a photocopy of the document by express mai[ (furnished and paid for by the employer). 7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the Employer must forward the employee's documentation to DHS as described in the preceding paragraph. The Employer agrees to resolve the case as specified by the DHS representative who wi[[ determine the photo match or mismatch. 8. DHS wil[ electronicalty transmit the result of the referrat to the Employer within 10 FederaI Government work days of the referralunless it determines that more than L0 days is necessary. 9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. ARTICLE IV SERVICE PROVISIONS A. NOSERVICE FEES 1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an Employer wilI need a personal computer with lnternet access. ARTICLEV MODI FICATION AN D TERM I NATION A. MODIFICATION 1. This MOU is effective upon the signature of all parties and shal[ continue in effect for as long as the SSA and DHS operates the E-Verify program unless modified in writing by the mutuaI consent of a[[ parties. 2. Any and al[ E-Verify system enhancements by DHS or SSA, inctuding but not [imited to E-Verify checking against additionaI data sources and instituting new verification policies or procedures, wilI be covered under this MOU and will not cause the need for a supplementaI MOU that outlines these changes. Page 10 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 Eflerify ffi,ffi E-VER|FY tS A SenVtCE OF 0tr54{D 554 Company lD Number: 1.13770 B. TERMINATION 1. The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days prior written notice to the other parties. 2. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the Employer's participation in E-Verifu, with or without notice at any time if deemed necessary because of the requirements of [aw or policy, or upon a determination by SSA or DHS that there has been a breach of system integrity or security by the Emptoyer, or a failure on the part of the Employer to comply with established E-Verify procedures andlor legaI requirements. The Employer understands that if it is a Federalcontractor, termination of this MOU by a ny party for any reason may negatively affect the performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is mandatory, termination of this by any party MOU may negatively affect the Employer's business. 3. An Employer that is a FederaI contractor may terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or completed. ln such cases, the Federal contractor must provide written notice to DHS. lf an Employer that is a FederaI contractor fails to provide such notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non- Federal contractor participants, and will be required to use the E-Verify procedures to verify the employment eligibility of all newly hired employees. 4. The Employer agrees that E-Verify is not liable for any [osses, financial or otherwise, if the Employer is terminated from E-Verify. ARTICLEVI PARTIES A. Some or att SSA and DHS responsibilities under this MOU may be performed by contractor(s), and SSA and DHS may adjust verification responsibilities between each other as necessary. By separate agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU. B. Nothing in this MOU is intended, or shoutd be construed, to create any right or benefit, substantive or procedurat, enforceabte at law by any third party against the United States, its agencies, officers, or employees, or against the Employer, its agents, officers, or employees. C. The Employer may not assign, directly or indirectly, whether by operation of law, change of control or merger, all or any part of its rights or obtigations under this MOU without the prior written consent of DHS, which consent sha[[ not be unreasonably withheld or delayed. Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void. D. Each party shatl be solely responsible for defending any claim or action against it arising out of or related to E-Verify or this MOU, whether civil or crimina[, and for any liabitity wherefrom, including (but not [imited to) any dispute between the Emptoyer and any other person or entity regarding the appticabitity of Section 403(d) of llRlRA to any action taken or allegedly taken by the Employer. Page 11 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 HF-Verify ffi@ g.VENIF ISASERVI(E OF Df,SATD SSA Company lD Number: 13770 E. The Employer understands that its participation in E-Verify is not confidential information and may be disctosed as authorized or required by law and DHS or SSA policy, including but not limited to, Congressional oversight, E-Verify pubticity and media inquiries, determinations of compliance with Federal contractual requirements, and responses to inquiries under the Freedom of lnformation Act (FOIA). F. The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate statement, representation, data or other information provided to DHS may subject the Emptoyer, its subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to L8 U.S.C. 1001 and/or; (2) immediate termination of its MoU andlor; (3) possibte debarment or suspension. G. The foregoing constitutes the full agreement on this subject between DHS and the Employer. To be accepted as an E-Verify participant, you should onlysign the Employer's Section of the signature page. lf you have any questions, contact E-Verify at 1-888-464-4218. Page 12 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 €llerify ffi@ Company lD Number: 113770 Approved by Employer VISU-SEWER, INC. Name (Please Type or Print) PATRICIA L EVANS Title Signature Electronically Signed Date 0411412008 Department of Homeland Security - Verification Division Name (Please Type or Print) USCIS Verification Division Title Signature Electronically Signed Date 0411412008 Page 13 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 lnformation Required for the E-Verify Program lnformation relating to your Company: Company Name VISU-SEWER,INC. Company Facility Address W23O N4855 BETKER DRIVE PEWAUKEE, WI53072 Company Alternate Add ress County or Parish WAUKESHA Employer ldentification Number 391219110 North American lndustry Ctassification Systems Code 237 Parent Company VISU-SEWER,INC. Number of Employees 100 to 499 Number of Sites Verified for 3 site(s) ffilterify ffi@ Company lD Number: :rrc720 Page 14 of 17 E-Verify MOU for Employers I Revision Date 06/0i/13 gFlterify ffi@ e.vailFv tsa sEnvtcE oFoHsatrD5sa IL MN WI Company lD Number: 13770 Are you verifying for more than 1 site? lf yes, please provide the number of sites verified for in each State Page 15 of 17 E-Verify MOU for Employers I Revision Date 06l0Il13 E-\ferify ffi@ Company lD Number: 1fi770 lnformation relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name HOLLY N SCHLISE Phone Number 2626952340Fax 2626952359Email hollv@visu-sewer.com Name Phone Number Fax Email NICOLE L CONRAD 7082370340 7082370360 N icoleC@visu-sewer.com Name Phone Number Fax Email DANIEL A PRZEWOZNIK 7082370340 7082370360 DanP@visu-sewer.com Name Phone Number Fax Email RONALD E FENNEY 7632520004 7632520008 ron@visu-sewer.com Name Phone Number Fax Email Name Phone Number Fax Email PATRICIA L EVANS 2626952340 2626952359 pat@visu-sewer.com MARY I CUMMINGS 7082370340 7082370360 maryc@visu-sewer.com Name Phone Number Fax Email Lindsav Golner 2626952340 lindsavq@visu-sewer. com Page 16 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 wEllerify ffi@ E.VEitfy t9asEnvtcE oFDflselD s5A Company lD Number: fi3720 This list represents the first 20 Program Administrators listed for this company Page 17 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 E An officiat website of the United States government Here's how you know EVerify Menu : E-Verifg Cose N umber : 2O23132183O09DJ Report prepored : 06 / 27 / 2O23 Compong lnformotion Company lD: 113770 Company Name: VISU-SEWER, INC Cfient Company lD: 11377A Client Company Name: VISU-SEWER, INC Emplogee lnformotion Name: Henry Brooks Date of Birth: 02/28/1978 U.S. Social Security Number: ***-**-7254 Employee's First Day of Employment: 05/12/2023 Citizenship Status: U.S. Citizen Document lnformotion List B Document: Driver's license or lD card issued by a U.S. state or outlying possession Document Subtype: Driver's License Document Number. **********6902 Expiration Date: 02/ 28 / 2031 State: Wisconsin List C Document: Social Security Card Cose lnformotion Case Status: Closed Case Submitted By: LINDSAY GOLNER Current Case Result Employment Authorized Reason for Closure: Employment Authorized Auto Close BID/PROPOSAL CITY OF SOUTH BEND Sewer and Manhole RehabilitationProject Name: Project Number: For Bids Due: Contractor Name: July 9,2024 122-019 Visu-Sewer LLC BID TAB Bidder (Firm): Address: City/State/Zip; BID TOTAL Visu-Sewe LLC W230 N4855 Betker Drive Pewaukee, Wl 53072 Telephone Number:( 262t 695-2 By Keith M. Alexander, PresidenVCEO (Printed Name of Person Signing) Item No.Description Quantity Unit Unit Price Total Amount 1 1 0" Pipe Rehabilitation 5602 LF $ u.l-on $3'ls.aqu nn 2 1 2" Pipe Rehabilitation 5731 LF $ u1.so $3tr^ qrlr .sc 3 1 5" Pipe Rehabilitation 2BB4 LF $ 8t".on $zqR.nrt[-rn 4 1 8" Pipe Rehabilitation 1516 LF $ ll< ,^r-$ tr{ 3{o^or 5 Manhole Rehabilitation 174 VF $ -qan^on $ zaz zro-r' 6 lnvert Repair, Shotcrete 2A CY $ ffis.oo $ l.t snn nn 7 I nvert Repair, Reinforcement 10 TON $ lrLo.nn $ L.l"nn.on 8 lnjection Grout 250 GAL $ ss.on $ l3'lso.on I Work Allowance - Additional Miscellaneous Work 1 LS $ 50,000 $ so,ooo 10 Work Allowance - Styrene Air Testing 1 LS $ 25,000 $ zs,ooo $ l,52R.5eo5o Version 611112024 Contractor's Bid for Public Works - I CITY OF SOUTH BEND, INDIANA CONTRAGTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Sewer and Manhole RehabilitationProject Name Project No. For Bids Due Gontractor Name: 122-019 July 9,2024 Visu-Sewer LLC The City seeks to enhance its ability to identiff responsive and responsible bidders on all City public works pro1ects by institution of comprehensive submission requirements in compliance with State law, Quality workmanship, efficient operation, safety, and timely completion of projects reguires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED wlTH YOUR BID. *THIS FORM ONLY APPLIES TO BIDS GREATER THAN $25O,OOO. * INSTRUCTIONS: lf you are a pre-qualified bidder, complete Section I only. lf you are not a pre-qualified bidder, complete Section ll only. Section ll acts as an application for pre-qualification. Submission of Section ll will allow the bidder to be considered for pre-qualification for bids with the City of South Bend Department of Public Works, Pre- qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 71 of The Responsible Bidding Ordinance No. 10975-23 (hereinafrer, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre-qualified must submit a complete application for continuation of "pre- qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre-Qualified Bidders") within twelve (12) months of obtaining pre-qualified standing. lf the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre- qualified contractor to submit its complete application for continuation of "pre-qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective immediately following the twelve (12) months of pre-qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-71 until "pre-qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre-qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-71 of the Responsible Bidding Ordinance no later than the date of the public bid opening. Version 5l2Ol2O24 POST BID SUBMISSIONS: Post+id submissions must be submitted in accordance with Section 6-72 of the Responsible Bidding Ordinance. The post-bid submission requirements are as follows: 1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. 2. Each subcontractor, whose portion of the project is estimated to be at least two-hundred fifty thousand dollars ($250,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontracto(s)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder for projects greater than $250,000 and all subcontractors performing work greater than $250,000 on a public works project are required to submit certified payroll utilizing the federalform known as WH-347 or a similarform on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Gertified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the Gity may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre-Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 512012024 I. PRE.QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) By checking this box, I hereby acknowledge that I am a pre-qualified bidder with the City of South Bend and that I have met the pre-qualification requirements within the last twelve (12) months. A copy of my Pre-Qualificatlon verification letter is attached. (ii) By checking'this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conducl random inquiries of my current and prior customers. (iii) By checking this box, I hereby acknowledge that apprenticeship and training programs that I participate in have graduated at least five (5) apprentices in each of the past five (5) years. (iv) By checking this box, I hereby acknowledge that all subcontractors performing work greater than $250,000 also meet the qualifications of the Responsible Bidder Ordinance. (b) Attachments: (i) (ii) (iii) (iv) lndiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the lndiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staffto complete the work. lt outlines how I intend to meet the staffing needs of the work. List of projects of similar size and scope of work performed in all areas, including the State of lndiana, within the last three (3) years. For every projecl, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labo/s Ofiice of Apprenticeship, or its successor organization. This includes, but may not be limited to, letters from apprenticeship coordinators detailing the bidder's association with the program, and the United States Department of Labor Office of Apprenticeship Certificates of Registration of Apprenticeship Programs for each type of work to be performed on the project. Version 5l2Ol2O24 II. PRE.QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE.QUALIFIED) (a) Acknowledgements: (i) _r'_ By checking this box, I hereby acknowledge that I am not a pre-qualified bidder with the City of South Bend. (ii) _/_ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all , information provided to the City shall be regarded as public records. (iii) '/ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished uPon request. (iv) / By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub-contractors have the necessary licenses to undertake the work called for in this bid. lf a sub- contractor loses their license at any point, it is the responsibility of that sub- ,/ contractor to notifY the CitY. (v) { By checking this box, I hereby acknowledge that apprenticeship and training programs that I participate in have graduated at least five (5) apprentices in each . of the past five (5) years. (vi) -/- By checking this box, I hereby acknowledge that all subcontractors performing work greater than $250,000 also meet the qualifications of the Responsible Bidder Ordinance. (b) Attachments: (i) -rL lndiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the lndiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). See attached List identiffing all former business names. See attached Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis-Bacon and related Acts, within the preceding five (5) years. None Statement about staffing capabilities, including labor sources. This stalement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. This includes, but may not be limited to, lefters from apprenticeship coordinators detailing the bidder's association with ( ii) (iii) /v L / r' (iv) (v) (v) Version 512012024 (vi) -1- (vii) -/- (viii) (ix) Date: Julv 9.2024 ,/ _/ the program, and the United States Department of Labor Office of Apprenticeship Certificates of Registration of Apprenticeship Programs for each type of work to be performed on the project. Not applicable for this project. Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in lC 4-13-18-5 or lC 4-13-18-6. See attached Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. See attached Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. None Llst of projects of similar size and scope of work performed in all areas, including the State of lndiana, within three (3) years prior to the date on which the bid is due. See attached (Sign Here) Keith M. Alexander (Print Name Here) Visu-Sewer. LLC (Name of Company) W23O N4R55 Flalkar f)rirra (Address of Company) Pewaukee (city) Wisconsin (State) (262\695-2340 (Telephone Number) Version 512012024 State of lndiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: l, DIEGO MORALES, Secretary of State of lndiana, do hereby certify that I am, by virtue of the laws of the State of lndiana, the custodian of the corporate records and the proper official to execute this certifi cate. I further certify that records of this office disclose that vtsu-sEWER, LLC duly filed the requisite documents to commence business activities under the laws of the State of lndiana on January 1.0, 1983, and was in existence or authorized to transact business in the State of lndiana on July 05,2024. I further certify this Foreign Limited Liability Company has filed its most recent report required by lndiana law with the Secretary of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to lndiana by the domestic or foreign entity and collected by the Secretary of State have been paid. ln Witness Whereof, I have caused to be affixed my signature and the seal of the State of lndiana, at the City of lndianapolis, July 05,2024 Dwft1*,4 DIEGO MORALES SECRETARY OF STATE 198301-314 / 2O2438s0768 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires on August 04,2024. f8l VSYi*rr;tfiws,ft..." www.visu-sewer.com b) Attachments: (ii) Former Business Names: 510911975 - Visu-Sewer Clean & Seal, lnc' 1010112008 - Visu-Sewer, lnc. 1012312023 - Visu-Sewer, LLC The entities continue to survive through the current name after business reorganization in November 2023 (iv) Visu-Sewer, LLC has sufficient employees on staff to complete the work I am bidding on. Individuals who perform work on the public work project, on behalf of Visu- Sewer, LLC, will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (v) (viii) Visu-Sewer, LLC has no federal, state or local tax delinquencies owed to Any federal, state or local taxing body in the preceding three years. Visu-Sewer, LLC W230 N4855 Betker Dr, Pewaukee, Wl 53072 (P) 800-876-8478 I 262-695-2340 (F) 262-695-2359 Equal Employment Opportunity/Affirmative Action Employer ptutcrFnf wtwwt@tfll* of P,yyrrxrfrrrl*W@raining, F*flvgw unil f,rxhrtFstldttn-pumua of PVryffihwsfi'rf snl W**ngGwtiftru{,n fiptgrrlfuuhrn.e/o*'cnland !a/tar,ed' r.r4.7.e.0"r*l Sl)renffi, llfitnil6laa tl4e Trrede - Ou,ttaoepiaut. eaall .edta4pefreg* lere d as p arl of l6e Xolt'on o{ frppren ftu es6ry ?.og-*,o ot.o-{onee ati6 /6u 6aszb slon{ar{s of opprenlicesfitpes la fifr'sfie d 6J/ t6n 3 eere la ryr of B o6o.e/taaaDot8"c"ctoryrofBa6*%eg*h'aliortAugust 13,20&tAdmtbh tn /*, fr2psn ticcs EY Am mizi, o Visu-SeweL lnG.L Inspect, Maintain. Rehabilitate. CONTROLLED SUBSTANCES/ALCOHOL POLICY Effective Date: June 1, 2019 For purposes of this Policy "Visu-Sewer", "the company", "company", "motor carrier", "we", and "our" are defined as Visu-Sewer, lnc. TABLE OF CONTENTS POLICY STATEMENT INTENT PURPOSE IMPLEMENTATION OF PROGRAMS .. EMPLOYMENT TERMS..................... COMMUNICATIONS EMPLOYEE TRAINING ..................... SELF-REFERRAL LEGALLY PRESCRIBED DRUGS ..... CONDITIONS OF EMPLOYMENT..... EMPLOYEE'S R|GHTS...................... DETECTION PROGRAM ................... Test Requirements Notification of Testing Employee Consent To Testing Types of Testing Pre-Employment Random Periodic.... Post-Accident /1njury..... Reasonable SusPicion .. Follow-up Collection Site .......... ..4 ..4 ..5 ..5 ..5 ..5 ..5 ..6 ..6 ..7 ..8 ..8 ..8 ..9 ..9 ..9 10 10 11 Specimen Collection for Drug and AlcoholTests Collection of Specimens ............. Custody and Control Form Laboratory Aspects of Testing Reporting Results Positive Test Results ............. Confidentiality............ 1 1 1 1 1 1 2 3 3 3 4 4 EMPLOYEE ASS ISTANCE PROGRAM REEMPLOYMENT OPPORTUNITIES .. DtsctPLtNARY ACT|ON........... LAWS RELATING TO DRUG TESTING POLICIES Unemployment lnsurance............. Workers Compensation ........... Drug Free Workplace Act........... The Americans with Disability Act ........... Family and Medical Leave Act........... Department of Transportation Federal Highway Administration ........... Federal Motor Carrier Safety Regulations ................... Controlled Substances/Alcohol Testing Program ........ Employees Subject To Testing Safety Sensitive Functions Alcohol Controlled Substances............... Prohibited Conduct Removal From Service ............ Prescribed Medications .............. Drug and Alcohol Background Check Notices of Testing Circumstances ........... Pre-Em ploymenVPre-Duty Post Accident ........... Random... Reasonable Suspension ........... Return To Duty Follow-Up lmplied Consent... Refusal To Submit On-Duty Time........ Testing Methodology ............ Alcohol Testing The Alcohol Testing Site .......... The Breath Alcohol Testing Form............ Transmission of Test Results .................. Refusal To Test and Uncompleted Tests Action on Positive Result Controlled Substance Testing ... Appropriate Laboratory... lnitial Screen................... 11 12 12 14 14 14 14 15 16 16 16 17 17 18 19 20 20 21 Confirmatory Tests Adulteration .............. Laboratory Reporting Of Test Results Designated Collection Sites ........ Security Chain of Custody And Collection Control .................. lndividual Privacy Specimen lntegrity And |dentity.............. Split Sample Procedures............ Transportation To Laboratory Failure To Cooperate ........... Controlled Substance Test Resu|ts ............. Disclosure Of lnformation To Third Parties ............... Notification Of Test Results Confidentiality and Recordkeeping ......... Employee Assistance Program Supervisory Training Referral, Evaluation And Treatment......... Return To Duty.... Discipline. Recordkeeping And Reporting Reporting Requirement (Management lnformation System) APPENDICES APPLICANT NOTIFICATION OF VISU-SEWER:S CONTROLLED SUBSTANCES/ALCOHOL POIICY............APPENDIX A ACKNOWLEDGMENT OF NOTIFICATION OF VISU-SEWER'S CONTROLLED SUBSTANCES/ALCOHOL POLICY APPENDIX B 32 33 33 34 34 34 35 35 35 35 36 36 40 42 42 44 44 44 45 46 46 46 SAFETY PERFORMANCE HISTORY RECORD (DOT REGULATED EMPLOYEES).APPENDIX C ACKNOWLEDGMENT OF RECEIPT AND REVIEW OF VISU-SEWER'S CONTROLLED SUBSTANCES/ALCOHOL POLICY APPENDIX D PREVIOUS PRE.EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT ............APPENDIX E AUTHORIZED M EDICAL FACI LITI ES/COLLECTION SITES REPORT OF REASONABLE CAUSE/SUSPICION APPENDIX F APPENDIX G POST-ACCI DENT/I NJU RY INSTRUCTIONS APPENDIX H AUTHORIZAT I ON FOR POST-ACCI DENT/I NJ U RYCONTROLLE D SUBSTANCES/ALCOHOL TESTING ..........APPENDIX I SPECIMEN COLLECTION PROCEDURE APPENDIX J ALCOHOL AND DRUG EMPLOYEE'S CERTIFIED RECEIPT APPENDIX K THIS PORTION OF THE PAGE HAS BEEN INTENTIONALLY LEFT BLANK POLICY Visu-Sewer prohibits employee use, possession, purchase, manufacture, sale, transfer, distribution, or dispensing of illegal substances at any time; use of alcohol on the job, and use of legal substances, drugs or alcohol that would impair the employee's ability to work. Questions relating to this policy should be directed to Keith Alexander, John Nelson, Mike Frailing, or Brian Baumann 382.601(b)1 . STATEMENT Visu-Sewer has a responsibility to provide a safe and healthy workplace for its employees The Company recognizes that the use and/or abuse of illegal/legal drugs and/or alcohol can have a significant impact on the workplace in terms of safety. Visu-Sewer has established a Controlled Substances/Alcohol Policy to protect the safety of its employees from those individuals who use or are impaired by drugs andior alcohol on the job. INTENT The practice of drug and alcohol abuse affects the health and welfare of the users, and all people who come in contact with that person. When certain individuals take it upon themselves to engage in activities which are counterproductive to a safe and healthy work environment, they jeopardize their future and the future of their fellow workers. Visu-Sewer cannot be responsible for these individuals or their actions. Our intent is not to interfere with the personal lives of our employees, but to provide a safe working environment for the security of all employees. PURPOSE The Policy's purpose is to help reduce substance abuse and other drug and/or alcohol related problems, work-related accidents, worker's compensation claims, absenteeism and tardiness problems, and health care costs; improve safety and productivity; meet the company's legal responsibilities to the general public and contribute to the health and well- being of the company's employees. IMPLEMENTATION OF PROGRAMS To demonstrate Visu-Sewer's commitment to enforcing the Policy, Visu-Sewer has established and implemented a detection program to ensure compliance with the Controlled Substances/Alcohol Policy. Visu-Sewer expects that all employees will fully and willingly participate in the programs with the knowledge that a safe, healthful and productive work environment is to the benefit of all. E TERMS Neither the implementation of this Policy nor any of the terms of this Policy is intended to modify the at-will nature of the employment relationship at Visu-Sewer or to othenruise create any contract, express or implied, with any employee, Employment with Visu-Sewer is considered "at-will," meaning that it is for no set duration and can be terminated by Visu- Sewer or the employee at any time, for any reason, unless prohibited by statute or public policy. 1 COMMUNICATIONS Applicants will be advised in writing of Visu-Sewer's Controlled Substances/Alcohol Policy for drug testing as a condition of employment at the time the applicant is given an application for employment(APPENDIX A - APPLICANT NOTIFICATION). The Controlled Substances/Alcohol Policy will be provided to the applicant upon request. The applicant will be required to sign an acknowledgment of notification of Visu-Sewer's Controlled SubstancesiAlcohol Policy (APPENDIX B - ACKNOWLEDGMENT OF NOT1F|CATION). Applicants for safety sensitive positions requiring a commercial drivers license will be requested to furnish Visu-Sewer with all information concerning prior participation in a drug and alcohol testing program (APPENDIX C - SAFETY PERF)RMANCE H|STORY REcoRD (Dor REGULATED EMPLjYEES and APPENDIK E - PREVtous PRE- EMPLOYMENT EM?LOYEE ALCOHOL AND DRUG IESI STATEMENI-). Employees newly hired by Visu-Sewer will be given the Controlled Substances/Alcohol Policy on their first day of employment. During the employee's orientation, the Policy will be reviewed with the new employee and any questions the employee may have regarding the Policy will be answered. An acknowledgment of receipt and review of the Policy will be signed jointly by the employee and a representative of Visu-Sewer's management as a commitment to comply and abide by the Policy as established. (APPENDIK D - ACKNOWLEDGMENT OF RECEIPT AND REVIEW Current employees will be issued the Controlled Substances/Alcohol Policy as it is established and periodically updated. Managers and supervisors will review the Policy with the employees and answer any questions the employees may have regarding the Policy. An acknowledgment of receipt and review of the Policy will be signed jointly by the employee and a representative of Visu-Sewer's management as a commitment to comply and abide by the Policy as established. (APPENDIK D - A)KNjWLEDGMENT oF RECEIPT AND REVIEW The Controlled Substances/Alcohol Policy will be reviewed at safety meetings to communicate Visu-Sewer's commitment to the Policy. Amendments and updates to the Policy will be provided and distributed to employees through various methods including but not limited to distribution of documents at safety meetings, postings on bulletin boards and in payroll check distribution. Visu-Sewer will communicate and provide this Policy to the business partners associated with Visu-Sewer including but limited to customers/clients, prime contractors, subcontractors, vendors, employment resources and recruiters and other interested ind ividuals and organizations. 2 EMP TRAINING Visu-Sewer will provide training for all employees consisting of at least the following elements: (1) the dangers of drug abuse in the workplace, (2) the effects and consequences of controlled substance use on personal health, safety and the work environment; and (3) the manifestation and behavioral changes that may indicate controlled substance use or abuse. Visu-Sewer will maintain documentation of training provided to employees. (APPENDIX K - ALCOHOL AND DRUG EMPLOYEE'S CERTTFTED RECETPT) SELF.REFERRAL Visu-Sewer has a significant interest in the safety, health and well-being of its employees, as well as the public, and supports those individuals who make a commitment to resolve their substance abuse problems. Employees who determine that they have a drug or alcohol abuse problem and self-refer themselves to a treatment and rehabilitation program for drug or alcohol abuse will be treated with maximum respect for confidentiality. Visu- Sewer may, at its sole discretion, elect to offer special consideration to any individual who comes forth voluntarily as opposed to those who are detected through the regular testing process. An employee who selects rehabilitation will comply with all requirements of that program to completion. Failure to do so or failure to make every effort at rehabilitation will constitute grounds for termination. Rehabilitation, if permitted at all, will be permitted only one time. An employee requiring a leave of absence for treatment purposes will be allowed to do so under the provisions of Visu-Sewer's Leave Of Absence as outlined in Visu-Sewer's Employee Reference Handbook. Health care benefits to pay the cost of treatment are detailed in Visu-Sewer's Employee Medical and Dental Benefit Plan. Payment for insurance premiums during the required leave of absence or reduction in hours as a result of treatment will be paid by Visu-Sewer as detailed in Visu-Sewer's Employee Reference Handbook and Employee Medical and Dental Benefit Plan. Employees who have voluntarily submitted to drug or alcohol treatment and rehabilitation programs will be subject to follow-up testing procedures established within this Policy. LEGALLY PRESCRIBED DRUGS Nothing in this Policy prohibits the appropriate use of prescription medication legally prescribed by a licensed physician. The use and possession of legally prescribed drugs is permitted on company premises and time provided the drug has been prescribed by a medical practitioner for the current use of the person in possession of the drug and consistent with that prescription. Possession of over-the counter drugs is also permitted, but any use of such drugs must be consistent with the manufacturer's instructions. lt is the employee's duty to discuss with his/her physician any effects that medication prescribed may have on the employee's ability to safely perform his/her job. lt is the responsibility of every employee to know if any substance, either over-the-counter or prescribed, can have any effect on judgment or performance. The employee should advise Visu-Sewer of medication requirements and any possible adverse effects that might affect their ability to work safely if the medication is taken while working their scheduled assignment. Visu- Sewer will make the determination as to whether the employee needs to be reassigned or 3 relieved of duties for the course of the medication for the safety of all. Visu-Sewer has the right to request that the drug be contained in the original prescription container, original over-the-counter container, or is in the employee's possession only in quantities sufficient for his/her shift. CONDITIONS OF EMPLOYMENT Visu-Sewer will enforce this Policy as a condition of employment. Employees will abide by the terms of this Policy as a condition of employment. Employees will be subject to drug and/or alcohol testing as set forth in this Policy. Drug and alcohol testing is mandatory for Visu-Sewer employees as a condition of employment. Employees are required to inform Visu-Sewer within 5 calendar days of the date of an arrest or a conviction for a violation of a criminal drug statute which occurred in the workplace as a condition of employment. EMPLOYEE'S RIGHTS Visu-Sewer is firmly committed to the fair and equal treatment of all employees under this Policy. The employee will be informed of the procedures of the Detection Program and will be advised of the reason for the tests, how the testing is to be conducted and the test's effect on the individual's employability. An employee has the right to refuse testing. The employee will be given the opportunity to provide medical justification for using drugs or to rebut the test findings. Employees have the right to request an employee-paid confirmatory retest. DETECTION PROGRAM The detection program establishes procedures to provide compliance with the Controlled Substance/Alcohol Policy. Test Requirements Prospective employees must submit to pre-employment drug and alcoholtesting DOT physicals, required for employment as a driver of company commercial motor vehicles, will include drug and alcohol testing. All employees are subject to random and/or periodic drug and alcohol testing unless exempt or prohibited by law. All employees employed in safety-sensitive positions are subject to random and/or periodic drug and alcohol testing. Safety-sensitive positions are defined by Visu-Sewer as positions where the employee's duties include driving of company owned vehicles, operating machinery/equipment, or handling materials that are considered safety-sensitive by the nature of the operation, process or materials composition., 352.601 (b)3 All employees are subject to post-accidenVinjury drug and/or alcohol testing when involved in a workplace injury or vehicle accident. All employees are subject to drug and alcohol testing for reasonable suspicion, Any employee who is required to submit to drug and/or alcohol counseling or a 4 o a a a a rehabilitation program is subject to follow-up drug and alcohol testing Notification of Testing Visu-Sewer will request employees and prospective employees to submit to testing as established by this Policy. The notification of testing will state the purpose of the testing Employee Consent to Testing Prospective employees and employees will be expected to sign a consent or release form authorizing the collection of the specimen, analysis of the specimen for designated controlled substances, testing of the breath sample and release of the results to Visu-Sewer. The employee will not be required to waive liability with respect to negligence on the part of any person participating in the collection, handling or analysis of the specimen or to indemnify any person for the negligence of others. lf the employee refuses to cooperate during the collection process (e.9., refusal to provide a complete specimen, complete paperwork, initial specimen, provide a breath sample, or othenivise fails to cooperate with the collection process in a way that prevents the completion of the test), the collection site person will inform Visu-Sewer's representative and document the employee's conduct on the Custody and Control Form or Breath Alcohol Testing Form. Any such conduct will constitute a refusal to test. All employees are expected to exercise good faith and cooperate during the collection process. Failure to do so will subject the employee to disciplinary action, up to and including discharge, independent and regardless of the results of any subsequent test. Types of Testing. Pre-Employment'382.601(b) 2, 5, 7 Each job applicant will be advised that a drug and/or alcohol test will be required as a part of pre-placement examination and that any job offer is contingent upon, among other things, a negative test. (APPENDIX A - APPUCANT NOTIFICATION OF Y/S U-S EW E R'S CO N T RO LLED S UBS T A N C E S/ALC O H O L P O U CY) Prospective employees will be notified in advance of said drug and alcohol test. lf the prospective employee refuses to submit to the drug and alcohol test, consideration for employment with Visu-Sewer will immediately cease. A prospective employee will not be allowed to begin work at Visu-Sewer until the results of the drug and alcohol test are known. lf the results of the test are positive, the prospective employee will be denied employment. Random All employees are subject to random drug and/or alcohol tests unless exempt or prohibited by law. All employees in safety-sensitive positions are subject to random testing. Every employee will have an equal chance of being selected to be drug tested each and every time the selection for random testing is conducted. At least 25o/o of Visu-Sewer's employees will be randomly tested for controlled substances every twelve months. At least 10% of Visu-Sewer's employees will be randomly tested for alcohol every twelve months. Random testing will take place once per quarter for a total of four times per year. Selection will be determined by the a 5 a a medical review organization contracted and authorized by Visu-Sewer to conduct the random selection. Separate and distinct random testing pools have been established for non-DOT and DOT employees. Appropriate safeguards have been established to ensure that the identity of individual employees cannot be determined prior to or at the time of their selection. Whenever an employee is randomly selected to be tested, he/she will be notified and instructed to report immediately to the collection site. Periodic Periodically, employees in safety-sensitive positions will be required to submit to an unannounced test for controlled substances. Selection will be determined by Visu- Sewer's management or by the requirements of any government agency or private business customer to which Visu-Sewer has established a contract for work performance (e.9. required testing of Visu-Sewer's employees by a customer for the express purpose of allowing Visu-Sewer's employees onto the job site). Such periodic testing may take place at any time during a calendar year. Employees will have an equal chance of being selected to be tested each and every time the selection for periodic testing is conducted. Appropriate safeguards have been established to ensure that the identity of individual employees cannot be determined prior to or at the time of their selection. Whenever an employee is selected to be tested, he/she will be notified and instructed to report immediately to the collection site. Post-Accident /lnjury As soon as practicable after an accident or injury, each employee directly involved or whose performance contributed to an accident or injury must submit to a drug and/or alcohol test. An accident is defined as: an OSHA recordable incident, acts or omissions resulting in near misses, and accidents involving a personal injury that requires treatment at a medical care facility; incident causing personal injury to another person who requires medical treatment at a medical care facility; and/or property or vehicle damage of $1,000.00 or more. The Department of Labor Occupational Safety and Health Administration (OSHA) defines a recordable incident as a work-related injury or illness that results in death, loss of consciousness, days away from work, restricted work activity or job transfer, or medical treatment beyond first aid. (APPENDIX H - POST ACCIDENT/INJURY INSTRUCTIONS). ln the event, post-accident testing is not administered within 2 hours of the accident, circumstances preventing the tests from being administered must be documented by the employee's supervisor. ln the event, post-accident alcohol testing is not administered within 8 hours of the accident, circumstances preventing the tests from being administered must be documented by the employee's supervisor. ln the event, post-accident controlled substances testing is not administered within 32 hours of the accident, circumstances preventing the tests from being administered must be documented by the employee's supervisor. 6 a Reasonable Suspicion Reasonable cause or suspicion is when the Company believes that the employee's appearance or conduct is indicative of the use of drugs and/or alcohol. ln addition to onthe-job performance, employees who have excessive absenteeism or other work-related symptoms may be subject to suspicion. lf, at any time, there is a reasonable suspicion that an employee is under the influence of drugs and/or alcohol, the employee will be required to submit to a drug and/or alcohol test. Reasonable cause or suspicion exists when there is no other ready explanation other than substance abuse or alcohol for an individual's conduct, behavior, appearance or actions. Reasonable suspicion is something more than a hunch, but not significantly more. lt is an observation of behavior which common sense, in light of all the circumstances, tells you may be drug or alcohol related. Common sense must be applied in light of all the circumstances and each case must be evaluated on its own merits. Reasonable suspicion will be determined by management that has been trained to determine reasonable suspicion. Reasonable suspicion will be based upon observable physical, behavioral, speech and performance indicators, alone or in conjunction with other factors including investigation of the employee or co- employees. Information may be accumulated and documented through a variety of methods Report of Reasonable Cause/Suspicion Documentation of the employee's conduct will be prepared and signed by the witness within 24 hours of the observed behavior or before the results of the test are released, whichever is earlier. Use of the reasonable cause/suspicion form to document observations is recommended (APPENDIX G - REPORT OF REASONA BLE CAUSE/SUSPIC/ON). Report of Reasonable Cause/Suspicion forms or other items or reports of documentation will be submitted to the Safety Director for review and action. Employee lnvestigation An employee's unusual behavior may be due to stress or occurrences in the employee's personal life. The employee will be asked to explain their behavior. Their reaction to questions will be monitored, taking special notice of the employee's speech and eyes, and any unusual odors detected during the interview. Drugs, opposed to alcohol, do not generally have a distinctive order. The employee's privacy will be respected as much as possible. Any information obtained in the investigation will be documented and considered confidential. a o Co-em ployee I nvestigation Co-employees will be questioned regarding the employee's performance, 1 a a unusual behavior and, if necessary, knowledge of use of any substances. The co-employee's identity and participation in the investigation will be kept confidential. Any information obtained in the investigation will be documented and considered confidential. The employee's privacy will be protected as much as possible. Follow-up Any employee who is required to submit or voluntarily submits to drug andior alcohol counseling or a rehabilitation program may not return to work until he/she has been evaluated by a professional in substance abuse treatment; has followed the recommendation of the professional in substance abuse treatment, including testing; has been certified by the professional in substance abuse treatment or the Company's medical review officer (MRO)as drug and alcohol free; and has successfully passed a drug and alcohol test by receiving a negative test result. Employees returning to work will be subject to afollow-upG testing consisting of periodic, unannounced testing as the Company may require to ensure that the employee is continuing to refrain from using drugs and/or alcohol or as the rehabilitation counselor may direct as part of the employee's treatment for a period of at least 12-months following completion of the program. Collection Site The collection site is a medical facility or other designated suitable place which may include a mobile facility where individuals present themselves for the purpose of drug or alcohol testing. The site will have available all the necessary equipment, personnel and materials for testing. The site will afford visual and aural privacy to the individual being tested and security sufficient to prevent unauthorized persons from tampering with specimens collected. ln the case of breath alcohol testing, the site should provide security sufficient to prevent unauthorized persons from seeing or hearing test results (APPENDIX F - AUTHORTZED MEDTCAL FAC\ LITIES/COLLECT\ ON S/rES). Specimen Gollection for Drug and Alcohol Tests ,3A2.001(b)6 The specimen collection for drug and alcohol tests will be at a collection site approved andior designated by Visu-Sewer. Except in emergency situations, appointments for specimen collection will be scheduled by Visu-Sewer for the employee during working hours at the convenience of Visu-Sewer. ln emergency (accident or injury) situations, the employee should report to the nearest specimen collection facility to where the emergency occurred. The employee will be required to present positive identification (e.g., photo l.D. card) at the time of testing. Visu-Sewer will provide instructions to the collection facility stating the requirements for specimen collection (APPENDIX H - POSI- ACCIDENT/INJURY /NSTRUCflONS, APPENDIX I - AUTHORIZATION FOR POSr- AC C I D E NT/ t N J U RY C O N T RO LLED S UBS TA N C E S/A LC O H O L rES I/NG ). Testi n g procedures will be explained to the employee (APPENDIX J -SPECIMEN COLLECTION PROCEDURE). The employee will be compensated for the time necessary to travel to and from the collection site and the length of time required to perform the collection process. 8 Collection of Specimens Visu-Sewer respects its prospective employees and employees and therefore subscribes to the collection protocol set forth by the Department of Health and Human Services (DHHS) which protects the privacy and confidentiality of the donor. This protocol allows for the submission of the specimen under closely structured conditions but behind either a closed door or a privacy partition. lt must be understood, however, that under circumstances established by DHHS, the donor may be asked to provide fresh specimen in the presence of a witness if the collector has reason to believe: (1) that the specimen is not that of the donor; (2) that the specimen has been adulterated or altered; (3) that the collection is part of a post-treatment monitoring program; or (4) that the donor has been known or suspected of adulterating previous specimen(s). All specimens are collected and processed by social security number and accession number for complete confidentiality. Specimens to be tested will be urine in the case of a drug test and breath in the case of a test for alcohol. Gustody and Control Form All specimens will be processed and monitored by way of an approved custody and control form which is used to track the specimen from point of submission to point of destruction. Employees will be required to sign the chain of custody form. Failure to do so will result in the need for a retest. However, an employee or perspective employee who refuses to sign after being requested to do so will be considered to have refused to submit to testing. lf submission testing is refused, the prospective employee will be denied employment or in the case of the employee, be subject to immediate termination of employment. Laboratory Aspects of Testing . Controlled Substances ln order to assure our prospective employees and employees the greatest accuracy and confidentiality, all drug testing will be conducted by a laboratory certified by Department of Health and Human Service (DHHS) and that participates in one of the following programs: guidelines of the Wisconsin State Lab of Hygiene, a laboratory certified by the National lnstitute on Drug Abuse (NIDA) meeting mandatory federal guidelines, a laboratory accredited by the College of American Pathologists in Northfield, lllinois, or a laboratory licensed to test for drugs by the New York State Department of Health, and will be conducted in two parts: Screening for five classes of drugs: amphetamines, benzoylecognine (cocaine metabolites), opiates, PCP, THC (marijuana metabolites); and Confirmation by gas chromatography/mass spectrometry (GC/MS). Note: Under Minnesota Statute (NonDot), the drugs most commonly tested for include: Alcohol, Amphetamines, Barbiturates (Phenobarbital, Secobarbital, etc.), Benzodiazepines (Vallium, etc.), Cocaine, Opiates (codeine, morphine, heroin), PCP (Phencyclidine or "Angel Dust") THC (metabolites Marijuana). a a 9 a Visu-Sewer reserves the right to perform tests for other illegal substances as well Results of the tests will be the property of Visu-Sewer and held in the strictest of confidence. No specimen will be considered epositiveG (positive is defined as the presence of one or more controlled substances at or above levels determined by the DHHS) until it has been confirmed at the cut-off levels established by DHHS. ln the event that no such levels have been established for that drug, Visu-Sewer will rely on the laboratory and its consultants to establish a eforensically accepted level.G Alcohol Alcohol testing will be conducted by a breath alcohol technician (BAT) trained to proficiency in the operation of the evidential breath testing device (EBT) he or she is using and in the alcohol testing procedures required for the alcohol testing. For evidential testing of breath, The EBT must be approved by the National Highway Traffic Safety Administration (NHTSA) for the evidential testing of breath and placed on NHTSA's Aconforming Products List of Evidential Breath Measurement DevicesG (CPL), and identified on the CPL as conforming with the model specifications available from the National Highway Traffic Safety Administration, Office of Alcohol and State Programs. A test result for alcoholwhich reveals a blood/alcohol content of .04 or greater is a positive test result under this Policy. All breath alcohol test results will be confirmed by the Breath Alcohol Technician (BAT). Reporting Results All positive drug test results will be first reported by the Medical Review Officer (MRO). lf the specimen is positive, the MRO will attempt to contact the employee at the daytime number provided at the time of urine specimen submission for the purpose of discussing the test results. Should the MRO fail to make contact on that attempt, he/she may contact Visu-Sewer to ask for assistance in reaching the employee. lf the MRO does not make contact within an additional maximum of five days or if the result appears to create immediate safety concerns, the MRO may disclose the results to Visu-Sewer prior to speaking with that employee. Visu-Sewer reserves the right to immediately remove the employee from active duty until such time as the MRO is able to make contact and provide a final result. lf, when the MRO reaches the employee, the employee is able to provide substantiation of legitimate use, the positive result will be reported to Visu-Sewer as enegativeG (negative is defined as the absence of a controlled substance at or above the levels of detection determined by DHHS). lf no legitimate reason for the positive result is found, that positive result will be provided to Visu-Sewer. Positive Test Results A positive test result does not automatically identify an employee or prospective employee as a drug or alcohol user. A medical review officer (MRO) will evaluate positive results with the employee or prospective employee to determine whether or not there are any reasons or interpretations of the test that may have resulted in a false positive test. Employees or prospective employees should report any overthe-counter or prescription medication that 10 the individual is currently taking or has recently taken and any other information relevant to the reliability of, or explanation for, a positive test result. Within three working days after notice of a positive test result on a confirmatory test, the employee or prospective employee may submit information to Visu-Sewer, in addition to any information already submitted concerning a claim that the positive test result was the result of overthe-counter or prescription medication, to explain that result, or may request a confirmatory retest of the original sample at the employee's or prospective employee's own expense. Confidentiality Any and all tests results are considered private and shall be kept strictly confidential. Visu-Sewer will not disclose tests results to another employer, a third-party individual, governmental agency, or private organization without the written consent of the employee or prospective employee tested. Employee health care records and documentation shall be maintained in a file separate from the employee's personnel file and treated as confidential information. Assess to the employee's health care records and documentation shall be limited and results will not be communicated to others outside of the employee's direct supervisory chain except when necessary in connection with any legal reporting requirements placed upon Visu-Sewer by government agencies imposing laws, regulations and guidelines for such reporting. Visu- Sewer may disclose the results of all drug/alcohol tests to its legal counsel, decision makers in a lawsuit, grievance, or other proceeding, including workers compensation or unemployment compensation benefits claims. Positive test results may not be used in a criminal action against the employee or prospective employee. Exceptions to the privacy and confidentiality disclosure limitations include: (1) use of the results in an administrative hearing, or judicial proceeding; (2) disclosure of the results to a federal agency under federal law, regulation, or order, or under federal contract compliance requirements; and (3) disclosure of the results to a substance abuse treatment facility for the purpose of evaluation or treatment of the employee. EM ASSISTANCE P ROGRAM Visu-Sewer's management is not qualified to diagnose,evaluate or counsel employees in drug and alcohol related matters. Visu-Sewer will make information available as to agencies that can assist the employee in obtaining confidential and professional assistance in resolving problems that are affecting their personal lives or job performance. The agencies will be staffed by qualified specialist who is qualified to deal with alcohol, drug and medical problems. An employee who selects rehabilitation will comply with all requirements of that program to completion. ln the event of a positive test or a refusal to submit to testing, Visu-Sewer will provide a list, upon request, of acceptable resources available to the employee for assessment and/or treatment. Although such assessment and/or treatment is conducted at the sole expense of the employee, Visu-Sewer requires that certified professionals actively involved in the substance abuse field be utilized. 11 The employee will not be qualified to work for Visu-Sewer until a professional in substance abuse treatment certifies that the employee has been rehabilitated. ln the event Visu- Sewer does not consider the substance abuse professional chosen by the employee to be acceptable, Visu-Sewer reseryes the right to request a second evaluation by an acceptable treatment professional at Visu-Sewer's expense. The evaluation will be conclusive evidence of the employee's rehabilitation or failure to rehabilitate. The employee may be permitted to return to work iflwhen he/she is able to demonstrate the successful completion of such assessment and/or any recommended treatment. REEMPLOYMENT OPPORTUNITIES ln the event the employee has completed an evaluation, treatment and rehabilitation program, Visu-Sewer may offer the employee the invitation to reapply and interview for the position he or she held at the time of termination. This re-application process must be within 60 days of the employee being released back to work by his or her treatment professional. Visu-Sewer does not guarantee an offer of employment would be granted. The decision to offer employment would be at the judgment of Visu-Sewer based upon the evaluation of the information received either verbally or in written document at the time of application and interview. As a condition of return, the employee will be required to submit, on demand, to drug follow-up for a period of up to 60 months. The number and frequency of such tests is determined by the substance abuse professional at its sole discretion. A positive test during or following the monitoring period will result in immediate termination with no further consideration for future employment. Rehabilitation after a positive test, if permitted at all, will be permitted only one time. prsctPLlNARYAcTtoN, 382.601 (b)4,9. Prospective employees refusing to complete and sign the consent/authorization form, or the chain of custody form at the collection site or to provide the specimen for testing will be denied employment. Prospective employees receiving a positive drug and/or alcohol test result will be denied employment. Any employee refusing to comply with this Policy will be terminated from employment. Any employee refusing to submit to testing requirements will be terminated from employment. Any employee refusing to complete and sign the consenUauthorization form, or the chain of custody form at the collection site or to provide the specimen for testing will be terminated from employment. Any employee who engages in any conduct that constitutes a refusal to submit to a controlled substance or alcohol test required under this Policy will be subject to immed iate termination. a a a a a t2 a O Any employee testing positive for drugs will be terminated from employment. Any employee found to be intoxicated and receiving a citation from a law enforcement official while driving a company vehicle will be terminated from employment. Any employee using or suspected of using illegal drugs or alcohol, or impaired by the use of legal drugs during regularly scheduled work hours, will be prohibited from driving a company vehicle or operating machinery. Any employee found to be in an intoxicated condition or suspected to be in an intoxicated condition, as a result of using drugs or alcohol during regularly scheduled work hours, will be required to undergo immediate drug and alcohol testing. Any employee found to be intoxicated as a result of using illegal drugs during regularly scheduled work hours will be terminated from employment. Any employee found to be intoxicated as a result of using alcohol during regularly scheduled work hours will be terminated from employment. Employees refusing to submit to evaluation by an approved professional drug or alcohol counselor and undergo comprehensive retesting will be terminated. Any employee showing a positive result on an alcohol detection test will be suspended without pay for a period of five (5) working days. During this time, the employee will be required to submit to evaluation by an approved professional alcohol counselor and undergo comprehensive retesting. An employee may not operate a company vehicle or equipment until a negative test result has been obtained. At any time during the employee's remaining employment, a second positive test shall result in immediate termination. Disciplinary actions will be taken against any employee who knowingly allows another employee to drive a vehicle or operate machinery while intoxicated or suspected of intoxication. lntoxication may be a result of drug, alcohol or a combination of both drug and alcohol use. The employee not reporting knowledge or suspicion may be suspended and possibly terminated from employment following review of events. ln the event, an employee is unable to be reached by the MRO for explanation of testing results showing a positive result on any drug or alcohol detection test, the employee will be suspended without pay until the MRO has been contacted. The employee will not be allowed to return to work until the MRO has issued a negative test result. ln the event the employee refuses to contact the MRO, the employee's employment will be terminated. Any employee found to be in possession of controlled substances in violation of this Policy is subject to immediate termination. a a o o a a a a a 13 a An employee may receive a verbal and/or written warning for any action that management may deem necessary to comply with this Policy when related to job performance, attendance, job responsibilities or safety. LAWS RELATING TO DRUG TESTING POLICIES Visu-Sewer is required to conform and comply with Federal and State laws and regulations. The responsibility to comply with those laws and regulations is also placed upon Visu-Sewer's employees. U nemployment lnsurance Benefits for unemployed workers in Wisconsin are provided by The Wisconsin Department of Workforce Development Unemployment lnsurance Program (Wisconsin Unemployment lnsurance Law, Chapter 108, Wisconsin Statutes)and in Minnesota are provided by the Federal Unemployment Tax Act, and the Minnesota jobs and training law (Minnesota Reemployment lnsurance). Under those laws, a claimant may be disqualified from receiving benefits if the employee has been terminated from employment and is guilty of misconduct. Misconduct may include failure to obey any reasonable rule adopted and reasonably enforced by the employer for the safety of the employee. Employee misconduct is additionally considered for failure to obey any reasonable rules of employment when the employee is employed. Workers Compensation Workers compensation insurance programs provide an injured employee with the means to obtain medical attention and reasonable compensation for the damage he or she suffered while on the job. lf an injury is caused by the failure of an employee to obey any reasonable rule adopted and reasonably enforced by the employer for the safety of the employee and of which the employee has notice; or if the injury results from intoxication of the employee, an employee's compensation and benefits may be reduced by up lo 15o/o, not to exceed $15,000. Drug Free Workplace Act The Drug Free Workplace Act of 1988 requires that all federal government contractors and organizations with federal grants maintain a drug-free workplace. The primary purpose of the Act is to prohibit the unlawful manufacture, distribution, possession or use of a acontrolled substanceG by an employee in any workplace involved in the performance of a government contract or work involving a government grant. The law applies to all employers/government contractors on contracts for property or services of a value of $25,000 or more and to all recipients of federal government grants in any amount. Under provisions of the Act, employers/contractors receiving grants who do not comply with the Act are subject to the following penalties: risk loss of the grant or federal contract; lose the right to future grants or government contracts, or if a decision is made to debar, Visu-Sewer may not receive a grant or take part in a contract for a period of up to five years. I4 As an employer that regularly contracts with the government for projects, Visu-Sewer is required to maintain a drug-free workplace by meeting specific requirements of the Act and regulations. Visu-Sewer will constantly make a good faith effort to keep the workplace drug free and comply with the requirements. Requirements of the Act have been met in the implementation of Visu-Sewer's policies and procedures published and outlined in this Policy. ln addition, Visu-Sewer's employees must abide by the Policy established and published by Visu-Sewer. Employees are required to notify Visu-Sewer if they are convicted of a criminal drug offense occurring in the workplace (including misdemeanors for a violation occurring on company property or during working time) within five (5) days after conviction A conviction includes any finding of guilty (including one agreed to by the employee) or plea of no contest or impositions of a fine, jail sentence, or other penalty. Visu-Sewer must notify the government contracting agency, or grant agency, of all criminal convictions of employees, and do so within ten (10) days of learning of the conviction. Visu-Sewer is required to take disciplinary action against employees convicted of criminal drug activity. Those actions may range up to and include termination of employment and/or require mandatory participation in a treatment program. Disciplinary action must take place within thirty (30) days after Visu-Sewer becomes informed of a conviction. The satisfactory participation in a drug abuse assistance or rehabilitation program must occur within 30 calendar days. The program must be approved for such purpose by a federal, state or local health, law enforcement or other appropriate agency. The Drug Free Workplace Act does not require testing of employees to determine use of illegal drugs. Some government agencies, such as the Department of Transportation, require employee testing. The Americans with Disability Act The Americans with Disabilities Act (ADA) of 1990 prohibits discrimination against those who have a drug or alcohol addiction or are perceived as having had a drug or alcohol problem or addiction. lndividuals currently engaging in the illegal use of drugs are excluded from protection as aqualified individuals with disabilitiesG under the Act. lndividuals may be denied employment or may be terminated for current drug use because they are using an illegal substance which excludes them from protection under the ADA. Alcoholics, in contrast, may not be denied employment or terminated as a result of their use of a legal substance. Employers may engage in drug testing prior to an offer of employment, since the ADA specifically provides that drug tests are not medical examinations. Alcoholics are only denied protection under the ADA when their use of alcohol impairs their ability to perform their required job duties. The ADA specifically provides that employers may require alcoholics to meet the same qualification and performance standard that are applied to other employees. Alcoholics will not be excluded from protection under the ADA for current alcohol use, but can be subject to discipline for unsatisfactory conduct regardless of whether such conduct resulted from the individual's alcoholism. 15 Family and Medical Leave Act Leave under the Family and Medical Leave Act (FMLA) may only be taken for treatment of substance abuse by a health care provider or by a provider of health care services on referral by a health care provider. Absence because of the employee's use of the substance, rather than for treatment, does not qualify for leave under the FMLA . Department of Tra nsportation Employees covered under the Department of Transportation rules are subject to random drug testing. Tests for marijuana, cocaine, opiates, and other illegal drugs must be conducted under the Department of Transportation regulations. Tests for the presence of alcohol or other drugs may also be conducted as required under the regulations. Federal Highway Adm inistration The Federal Highway Administration and the U.S. Congress have determined that alcohol abuse and illegal drug use pose specific dangers to the safety and welfare of the Nation. ln fact, Congress specifically noted that the use of alcohol and illegal drugs has been demonstrated to significantly affect the performance of individuals involved in the operation of trucks and has been proven to have been a critical factor in transportation accidents. Visu-Sewer >s Policy mirrors the Federal Highway Administration's policy in that drivers on the highways of the Nation be free from the influence of drugs and alcohol. The Federal Highway Administration United States Department of Transportation (DOT) drug testing regulations require companies engaged in for-hire or private truck operations to conduct mandatory drug and alcohol testing of their interstate and intrastate commercial motor vehicle drivers. The DOT's regulations prohibit commercial motor vehicle drivers from performing any safety-sensitive function (including driving) whenever a driver has either used, tested positive, or refused to be tested for drugs or alcohol. These regulations cover any truck driver who must obtain a commercial drivers license (CDL) to operate a vehicle in excess of 26,000 pounds, or a vehicle used to transport hazardous materials. Federal Motor Carrier Safety Regulations The Federal Highway Administration and the U.S. Congress have determined that alcohol abuse and illegal drug use pose specific dangers to the safety and welfare of the Nation. ln fact, Congress specifically noted that the use of alcohol and illegal drugs has been demonstrated to significantly affect the performance of individuals involved in the operation of trucks and has been proven to have been a critical factor in transportation accidents. From a safety standpoint, the importance of the driver is emphasized by the government's concern evidenced by the regulatory requirements for driver qualification in Parts 383 and 391 of the Federal Motor Carrier Safety Regulations (FMCSR) of the U.S. Department of Transportation, as well as similar requirements of individual states. The purpose of the FMCSR is to promote safety of operations on the Nation's highways, not only for the general driving public but also for the carriers and their drivers. The requirements of the FMCSR place certain specific responsibilities on both Visu-Sewer and the driver for compliance with the 16 regulations. Where the driver is charged with the compliance to a requirement, Section 390.11 makes Visu-Sewer responsible for requiring driver compliance. Visu-Sewer's Policy mirrors the Federal Highway Administration's policy in that drivers on the highways of the Nation be free from the influence of drugs and alcohol. The information presented in this Policy is current at the time of the Policy's issuance. Any changes to the FMCSR will govern the Program as it pertains to Visu-Sewer's Policy. Controlled Substances/Alcohol Testing Program ln order to achieve the goal of ensuring a drug and alcohol-free transportation system, as well as to comply with requirements of the Omnibus Transportation Employee Testing Act of 1991 and the Federal Motor Carrier Safety Regulations, Visu-Sewer has developed and established a controlled substance/alcohol testing program that complies with Part 382-Controlled Substances and Alcohol Use and Testing, and Part 40 Procedures For Transportation Workplace Drug and Alcohol Testing Programs published in the Federal Motor Carrier Safety Regulations. The purpose of Part 382 is to establish programs designed to help prevent accidents and injuries resulting from the misuse of alcohol or use of controlled substances by drivers of commercial motor vehicles. Part 40 establishes procedures for alcohol or controlled substances testing to be conducted under the programs established by Part 382. The Program is designed to help prevent accidents and injuries resulting from the misuse of alcohol and controlled substances by drivers of commercial motor vehicles. While it is difficult to estimate the precise cost to society from alcohol misuse, there is no doubt that the cost is enormous. The potential effects of alcohol misuse are substantial in terms of lives lost, personal injuries, property damage, business losses (lost productivity, absenteeism, increased health care costs, etc.) and environmental damage. lmplementation of this Program will also help discourage substance abuse, reduce absenteeism, accidents, health care costs and other drug-related problems, and operate as a deterrent to those individuals who might be tempted to try drugs for the first time or who currently use drugs. Finally, we believe that this program will enhance the safety and health of our employees and the users of the highways by fostering the early identification and referral for treatment of workers with drug or alcohol abuse problems. Visu-Sewer's drug and alcohol testing program is designed to create a drug and alcohol-free transportation system and to provide help to those employees who may be suffering from problems with chemical dependency. The program has therefore been developed in compliance with federal regulations in a manner which ensures accurate and reliable test results, thereby eliminating the possibility of any "false positives." lt also contains procedures designed to recognize and respect the dignity and privacy of all of our employees. We have established an appropriate referral, evaluation and treatment programs designed to help those individuals desirous of treating problems with alcohol and drug abuse. I1 Employees Subject To Testing The Part 382 regulations do not end Visu-Sewer's authority to include requirements not listed in Part 382. ( ' 382.171) Visu-Sewer's Policy meets and often exceeds the requirements required by the Federal Motor Carrier Regulations. The drug and alcohol testing required under this Policy will apply to any individual who operates a commercial motor vehicle in interstate or intrastate commerce and is required to possess a commercial driver's license. The requirements of this Policy will therefore specifically apply to employees who work in positions that require operation of a commercial motor vehicle and possession of a commercial driver's license. For purposes of this Policy, a "commercial motor vehicle" is defined as a motor vehicle or combination of motor vehicles used to transport passengers or property which: Has a gross combination weight rating of 26,001 or more pounds inclusive of a towed unit with a gross motor vehicle weight rating of more than 10,000 pounds; or Has a gross vehicle rating of 26,001 or more pounds; or ls designed to transport 16 or more passengers, including the driver; or o a a a ls of any size and is used in the transportation of hazardous materials required to be placarded under the Hazardous Materials Transportation Act. A driver subject to this Policy will include any person who operates a commercial motor vehicle, including but not limited to the following: . Fulltime, regularly employed drivers; . Casual, intermittent or occasional drivers; and Leased drivers and independent, owner-operator contractors who are either directly employed by or under lease with Visu-Sewer or who operate a commercial motor vehicle at the direction of or with the consent of Visu- Sewer. The rules in Part 383, Commercial Driver's License Standard; Requirements and Penalties, are applicable to every person who operates a commercial motor vehicle in interstate or intrastate commerce and to all employers of such persons. Because this drug and alcohol testing program is required by the Federal Motor Carrier Safety Regulations, its provisions will apply to any individual who operates a motor vehicle on behalf of Visu-Sewer pursuant to any contract, lease or other agreement with Visu-Sewer, even though such individual may not be an employee of Visu-Sewer. However, mere compliance with the provisions of this Policy or the 1B a application of this Policy to any person shall not operate to convert any independent contractor or other person into an employee of Visu-Sewer unless such other circumstances indicate the existence of an employer-employee relationship. Safety-Sensitive Functions' 382.601 (b)3 Safety-sensitive function means all time from the time a driver begins to work or is required to be in readiness to work until the time he/she is relieved from work and all responsibility for performing work. The requirements of this Policy are often dependent upon an individual's performance of a "safety-sensitive" function, which will include any of the "on-duty" functions listed below: o All time at an employer or shipper plant, terminal, facility, or other property, or on any public property, waiting to be dispatched, unless the driver has been relieved from duty by Visu-Sewer; o All time inspecting equipment as required by 49 CFR '392.7, .8 or othenryise inspecting, servicing, or conditioning any commercial motor vehicle at any time; . All time spent at the driving controls of a commercial motor vehicle in operation; . All time, other than driving time, in or upon any commercial motor vehicle except time spent resting in a sleeper berth (a berth conforming to the requirements of '393. Z6; . All time loading or unloading a vehicle, supervising, or assisting in the loading or unloading, attending a vehicle being loaded or unloaded, remaining in readiness to operate the vehicle, or in giving or receiving receipts for shipments loaded or unloaded; . All time repairing, obtaining assistance, or remaining in attendance upon a disabled vehicle. a All time spent providing a breath sample or urine specimen, including travel time to and from the collection site, in order to comply with the random, reasonable suspicion, post-accident, or follow-up testing required by Part 382 when directed by Visu-Sewer. Performing any other work in the capacity, employ, or service of Visu-Sewer and o A driver will be considered to be performing any of the safety-sensitive functions Iisted above during any period in which the driver is actually performing, ready to perform or immediately available to perform any such function. I9 Alcohol For purposes of this Policy, "alcohol" means the intoxicating agent in beverage alcohol, ethyl alcohol, or other low molecular weight alcohols including methyl and isopropyl alcohol. "Alcohol use" means the consumption of any beverage, mixture, or preparation, including any medication, which contains alcohol. "Alcohol concentration" (or content) means the alcohol in a volume of breath expressed in terms of grams of alcohol per 210 liters of breath as indicated by an evidential breath test. A driver may not report for duty or remain on duty requiring performance of safety- sensitive functions while having an alcohol level of 0.04 or greater. The driver may not use alcohol while performing safety-sensitive functions or perform safety- sensitive functions within 4 hours after using alcohol. lf a driver is required to take a post-accident alcohol test, the driver may not use alcohol for 8 hours following the accident, or until a post-accident alcohol test has been taken, whichever happens first. The results of a breath test for the use of alcohol, conducted by Federal, State or local officials having independent authority for the test, shall be considered to meet the requirements of this section, provided such tests conform to the applicable Federal, State or local controlled substances testing requirements, and that the results of the tests are obtained by the employer. Controlled Substances For purposes of this Policy, acontrolled substances A mean those substances identified in '40.21 (a). Although this Policy prohibits the use of any controlled substance not lawfully prescribed by a physician, any drug test required under this Policy will analyze an individual's urine to test for the presence of the following substances: . Marijuana. Cocaine. Opiates. Amphetamineso Phencyclidine The driver may not report for duty or remain on duty and perform safety-sensitive functions if he/she has used drugs. Visu-Sewer may require the driver to inform Visu-Sewer if drugs are being used to treat a medical condition. (Exception: lf the driver is using a drug under the direction of a licensed medical practitioner, and he/she has been advised by the medical practitioner that the drug will not affect his/her ability to safely operate a commercial motor vehicle.) The driver may not report for duty, remain on duty, or perform a safety-sensitive function if the driver has tested positive for drugs. The results of a urine test for the use of controlled substances, conducted by Federal, State or local officials having independent authority for the test, shall be considered to meet the requirements of this section, provided such tests conform to the applicable Federal, State or local controlled substances testing requirements, and that the results of the tests are obtained by the employer. 2o Prohibited Conduct'382.601(b)4 Company Policy and the Federal Motor Carrier Safety Regulations prohibit the followingcondu-ct as it relates to the use of alcohol and drugs with respect to the operation of a commercial motor vehicle:. No person will be "physically qualified" to drive a motor vehicle if he or she uses a Schedule I drug, amphetamine, narcotic or any other habit forming drug, or if he or she has a current clinical diagnosis of alcoholism. (, 391 .41 (b)(1 2), (1 s)). . No driver may be on duty and possess, be under the influence of or use any Schedule I drug, amphetamine, narcotic or other impairing substance. (,392.4). . No driver may use or be under the influence of alcohol within four (4) hours before going on duty, operating or having physical control of a motor vehicle. ('se2.5(a)(1)). . No driver may use alcohol or be under the influence of alcohol or have any measured alcohol concentration or detected presence of alcohol while on duty, operating or having physical control of a commercial motor vehicle. ('se2.5(a)(2))- . No driver may be on duty or operate a commercial motor vehicle while the driver possesses an alc6holic beverage, except that which is manifested and transported as part of a shipment. ( '392.5(a)(3)). o No driver will be permitted to be on duty or operate a commercial motor vehicle if his general appearance, conduct or other substantiating evidence indicates thafhe appears to have used alcohol within the preceding four (4) hours. ('392.5(b)). o A person will be disqualified from driving a motor vehicle for a minimum of one year if he is convicted of operating a commercial motor vehicle while unddr the influence of a drug or alcohol (including any incident in which the driver's blood alcohol concentration is 0.04o/o or more); refusing to undergo a test required to check for any of the above; or using a commercial motor vehicle to manufacture, distribute or dispense a controlled substance. ('383.51). Visu-Sewer's Policy and the Federal Motor Carrier Safety Regulations also prohibit the following conduct as it specifically relates to drug and alcohol testing under this Policy: . No driver may report for duty or remain on duty requiring the performance of safety-sensitive functions while having an alcohol concentration of 0.04 or greater. ('382.201). . No driver may be on duty or operate a commercial motor vehicle while the driver possesses alcohol, unless the alcohol is manifested and transported as part of a shipment. ('382.204). 21 . No driver may use alcohol while performing safety-sensitive functions. (,382.205). . No driver may perform safety-sensitive functions within four hours after having used alcohol. (,382.207). o No driver required to take a post-accident alcohol test under this Policy may use alcohol for 8 hours following the accident, or until he/she undergoes a post-accident alcohol test, whichever occurs first. (,3A2.209). . No driver may report for duty or remain on duty requiring the performance of safety-sensitive functions when the driver uses any confrolled substance.(, 382.213). . No driver may report for duty, remain on duty or perform a safety-sensitive function, if the driver tests positive for controlled substances. ( ;SAZ.Z1 51. . No driver may refuse to submit to any alcohol or controlled substance test required under this Policy. (, 382.21 1). ln the event Visu-Sewer has actual knowledge that a driver has violated any of the 9bov9 prohibitions, it will prohibit him/her from performing any safety-sensitive functions. Removal From Service A driver who has engaged in any prohibited conduct will be immediately removed from service and disqualified from the performance of any safety-sensiiive functions, including driving a commercial motor vehicle, unless and until that driver has been certified as fit to return to duty, The employee will also be subject to disciplinary action as established by this Policy. Any driver requested to submit to an alcohol test required under this Policy and found to have an alcohol concentration of 0.02 or greater, but less than 0.b4, will be disqualified from performing or continuing to perfoim any safety-sensitive functions, including driving a commercial motor vehicle, until the start of the employee's next regularly sche.9lled duty period, but not less than 24 hours following administration of the test. '382.601(b)10. Prescribed Medications The prohibitions outlined above do not apply to the use of a controlled substance pursuant to the instructions of a licensed physician who is familiar with the driver's medical history and assigned duties and has advised him/her that the substance will not adversely affect his/her ability to safely operate a commercial motor vehicle. All employees subject to this Policy will therefore be required to notify Visu-Sewer of his/her use of any medication prescribed by a physician. Any driver requested to submit to a drug test under this Policy will also be given the opportunity to list any prescribed medication that heishe may be taking or may have recently taken on the back of the employee's copy of the Urihe Custody and Control form provided at the collection site. The driver will then have the opportunity to 22 discuss the use of this medication with the medical review officer and may be required to identify the physician prescribing the medication and authorize the MRO to discuss the use of the medication with that physician, including its possible side effects and its relationship to the driver's ability to safely operate a commercial motor vehicle. ln the event it is determined that a driver is taking or is under the influence of a prescribed medication that will adversely affect his/her ability to safely operate a commercial motor vehicle and/or pose a significant risk of substantial harm to the driver or the general public, the driver will be removed from the performance of any safety-sensitive functions and/or placed on a medical leave of absence until that threat is acceptably reduced or eliminated. Visu-Sewer further reserves the right to place any employee taking a prescribed medication on a temporary medical leave of absence untilthe information described above is provided. Drug And Alcohol Background Check Any driver Visu-Sewer intends to hire or use to perform a safety-sensitive function wilt be required to undergo a background check to determine his/her compliance with the drug and alcohol prohibitions of the Federal Motor Carrier Safety Regulations during the previous 2 years. All drivers will therefore be required to sign an appropriate consent form authorizing their previous employers to release this information to Visu-Sewer (APPENDIX C - SAFETY PERFORMANCE HISTORY RECORD (DOT-REG U LATED EMPLOYEES). Visu-Sewer will then obtain information on the driver's alcohol tests with a concentration result of 0.04 or greater, positive drug test results and refusals to be tested, within the preceding 2 years from all of the driver's previous employers during that time period. This information may be provided through a personal interview, telephone interview, letter or other confidential method and will be maintained in a confidential reference file. Visu-Sewer will make a good faith effort to obtain and review the above information prior to allowing a driver to perform a safety-sensitive function. lf this is not feasible, Visu-Sewer will attempt to obtain the required information within 14 days after the first time the driver performs a safety-sensitive function, regardless of that individual's subsequent performance of those duties. No driver will be allowed to perform a safety-sensitive function if this information has not been obtained within 14 days, unless Visu-Sewer is unable to do so through no fault of its own. ln the event of such a circumstance, Visu-Sewer will document its efforts to obtain the requested information in the reference file. No driver will be allowed to perform a safety-sensitive function if Visu-Sewer discovers that he/she has had an alcohol test with a concentration of 0.04 or greater, a verified positive drug test result or has refused to be tested, unless and until Visu-Sewer confirms that the driver has undergone an assessment by a substance abuse professional (SAP), has complied with any recommendations the SAP may have made with respect to rehabilitation, and has passed return-to-duty drug and/or alcohol tests. Notice Of Testing Gircumstances Before performing any alcohol or controlled substances test under this Policy, Visu- 23 Sew_er will notify a driver that the test is being required pursuant to this Policy and the Federal Motor carrier Safety Regulations. Visu-Sewer will not, however, represent that any requested test is required by federal regulations if, in fact, the individual to be tested is not subject to those regulations. Testing procedures for alcohol and drug tests will be conducted under Part 382 will follow the procedures listed in Part 40 (APPENDIX J - SPECIMEN COLLECTION PROCEDURE). . Pre-Employment/Pre-Duty Prior to the first time a driver performs a safety-sensitive function for Visu- Sewer (including prospective employees and employees transferring into a position requiring the operation of a commercial motor vehicle), he/she will be required to undergo testing for alcohol and controlled substances and will not be allowed to perform any such function unless a verified negative drug test result is received from the medical review officer. Post-Accident Any driver involved in an accident will be required to submit to tests for alcohol and controlled substances as soon as practicable following the accident, if the driver: a . Was performing safety-sensitive functions with respect to the vehicle and the accident involved the loss of human life; or . Received a citation under State or local law for a moving traffic violation arising from the accident. For purposes of this Policy, an "accident" is defined as an occurrence involving a commercial motor vehicle operating on a public road which results tn: . A fatality; . Bodily injury to a person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident; or . One or more motor vehicles incurring disabling damage as a result of the accident, requiring the vehicle to be transported away from the scene by a tow truck or other vehicle. Exception. This section does not apply to: occurrence involving only boarding or alighting from a stationary motor vehicle; or an occurrence involving only the loading or unloading of cargo; or an occurrence in the course of the operation of a passenger car or a multipurpose not-for-hire passenger vehicle. Drivers are prohibited from using alcohol for 8 hours following any accident or until the required post-accident alcohol test is administered, whichever occurs first. Every effort will be made to conduct post-accident drug and alcohol tests within 2 hours following an accident. Any driver involved in an accident must therefore remain readily available for testing and will be considered to 24 a have refused to submit to testing if he fails to do so. This requirement will not, however, require a driver to delay any necessary medical attention for injured people following an accident or to remain at the scene of an accident when his/her absence is necessary to obtain assistance in responding to the accident or to obtain necessary emergency medical care. ln order to ensure expeditious testing, we will provide all drivers with information, procedures and instructions explaining our post-accident testing requirements. These instructions will be distributed to each driver prior to his/her operation of a vehicle covered by this Policy (APPENDIX H - POST-ACCIDENT/INJURY INSTRUCTIONS, APPENDIX I - AUTHORIZATION FOR POSI- AC C I D E NT/t N J U RY C O NT RO LLED S UBS TA N C E S/A LCO H O L rES r/NG ) ln the event an alcohol test is not administered within 2 hours following an accident, Visu-Sewer will prepare and maintain a record stating the reasons why the test was not promptly administered. lf an alcohol test is not administered within 8 hours following an accident, Visu-Sewer will make no further effort to administer an alcohol test and will document the reasons why the test was not administered within 8 hours. ln the event a drug test is not administered within 32 hours following an accident, Visu-Sewer will cease its attempts to administer any further testing and prepare and maintain a record stating the reasons why the test was not promptly ad ministered. The results of any breath test for the use of alcohol or a urine test for the use of controlled substances, conducted by Federal, State, or local officials having independent authority for the test, will be considered to meet the requirements of this section, provided such tests conform to applicable Federal, State or local requirements, and the results of the tests are obtained by Visu-Sewer. Random Both Visu-Sewer and the Department of Transportation believe that random drug and alcohol testing is an essential part of any program seeking to ensure a drug and alcohol-free transportation system. All drivers subject to this Policy will therefore be required to submit to random drug and alcohol testing. Visu-Sewer will conduct random alcohol tests at a minimum annual percentage rate of 10 percent of the average number of driver positions. The minimum annual percentage rate for random controlled substances testing will be 50 percent of the average number of driver positions. (lf these rates are subsequently increased or decreased by the FHWA, we will provide all drivers with written notice of the change.) lf a driver performs functions subject to random drug or alcohol testing requirements of another DOT agency, the driver will be tested at the rate of that agency which regulates more than 50 percent of the driver's safety- sensitive functions or those that take the greatest percentage of his/her time. ln the event of regulation by another DOT agency, Visu-Sewer will conduct random alcohol and/or drug tests by establishing separate random testing 25 a pools for each agency; or establishing one random testing pool with selection to occur at the highest minimum rate established by any agency to which Visu-Sewer is subject. The random selection process will be completely objective and anonymous and will utilize a scientifically valid method such as a random number table or a computer-based random number generator matched with drivers' Social Security numbers, payroll identification numbers, or other comparable identifying numbers. The tests will be unannounced and the dates for testing will be reasonably spread throughout the course of the year. All drivers will have an equal chance of being tested at any time, regardless of the number of his/her previous selections. When Visu-Sewer requires non-DOT employees to submit to random drug and/or alcohol testing, those employees will be selected for testing from a random testing pool separate and distinct from any pool containing drivers subject to FHWA-mandated random testing. Any driver notified of his/her selection for random alcohol andior controlled substances testing will be expected to proceed to the test site immediately. lf a driver is performing a safety-sensitive function at the time of his/her notification of a random test requirement, he/she will be required to cease performing the safety-sensitive function and proceed to the testing site as soon as possible. However, a driver will only be required to submit to a random alcohol test if the driver is performing a safety-sensitive function, is about to perform a safety-sensitive function, or has just ceased performing a safety-sensitive fu nction. Reasonable Suspicion Whenever Visu-Sewer has reasonable suspicion to believe that a driver has engaged in prohibited conduct, except for the prohibitions on possession of alcohol (49 CFR ,382.204), it will require that driver to submit to an alcohol and/or controlled substances test. However, any such suspicion must be based upon specific, contemporaneous, articulable observations concerning the appearance, behavior, speech or body odors of the driver, which may include indications of the chronic and withdrawal effects of controlled substances. These observations will only be made by a supervisor or company official who has received appropriate training and will be documented by that individual in a Report of Reasonable Cause/Suspicion within twenty-four (2$ hours after his/her observations, or before any drug test results are released (APPENDIX G - REPORT OF REASONABLE CAUSE/SUSP/C/OM. Any person who makes a determination that reasonable suspicion exists to require a driver to submit to an alcohol test will not be permitted to conduct the alcohol test for that driver. A reasonable suspicion alcohol test will only be required if the reasonable suspicion observations are made during, just preceding or just after the period of the work day that a driver is required to be in compliance with this Policy. A driver will therefore be directed to undergo reasonable suspicion alcohol test only while performing a safety-sensitive function, just before the performance of a safety-sensitive function, or just after the performance of ZO such functions. Every effort will be made to conduct any required reasonable suspicion alcohol test within 2 hours of the reasonable suspicion determination. lf a reasonable suspicion alcohol test is not administered within 2 hours following the reasonable suspicion determination, Visu-Sewer will document the reasons why the test was not promptly administered, and continue its effort to administer an alcohol test for up to 8 hours following the reasonable suspicion determination. lf the test is not administered within 8 hours following the reasonable suspicion determination, Visu-Sewer will no longer attempt to administer an alcohol test and will document the reasons for its inability to do so. Notwithstanding the above testing requirements, a driver may not report for duty or remain on duty requiring the performance of a safety-sensitive function if that driver is under the influence of or impaired by alcohol, as shown by the behavioral, speech and performance indicators of alcohol misuse. Any such driver will not be allowed to perform or continue to perform a safety-sensitive function until the driver undergoes an alcohol test yielding an alcohol concentration level of less than 0.02; or twenty-four hours have elapsed following the reasonable suspicion determination. Visu-Sewer will not take any disciplinary action against a driver based solely upon observations of the driver's behavior and appearance, with respect to alcohol use, in the absence of an alcohol test, unless such conduct warrants referral to a substance abuse professional for an assessment, if appropriate. ln any reasonable suspicion testing circumstance, a Company representative will transport the individual to an appropriate collection facility and await the completion of the collection procedure. The Company representative will then transport the individual back to Visu-Sewer's premises, where a spouse, family member or other individual will be contacted to transport the individual home. ln the event no such individual is available, Visu-Sewer will contact a taxi to transport the driver home. lf the reasonable suspicion test result is negative, Visu-Sewer will reimburse the employee for the cost of the taxi. lf the employee refuses to comply with any of these procedures and attempts to operate his/her own vehicle, Visu-Sewer will take appropriate efforts to discourage him from doing so, up to and including contacting local law enforcement officials. Any employee failing to cooperate with any of the above procedures will be subject to discipline, up to and including discharge. ln the event Visu-Sewer determines that a driver is in possession of alcohol in violation of this Policy, Visu-Sewer will utilize the disciplinary policy outlined in this Policy as a course of action. Return-To-Duty Before a driver who has engaged in any conduct prohibited by this Policy will be allowed to return to duty to perform a safety-sensitive function, he/she will be required to undergo return-to-duty alcohol and/or controlled substance tests, with results indicating an alcohol concentration of less than 0.02 and a verified negative for controlled substances use, respectively. aa a a Follow-Up Any employee determined by a substance abuse professional to be in need of assistance in resolving problems associated with alcohol misuse and/or the use of controlled substances will be subject to additional, unannounced follow-up testing for alcohol and/or controlled substances as directed by the SAP. However, any recommended follow-up testing for alcoholwill only be required just before, during or just after the driver has performed a safety- sensitive function. lmplied Gonsent Any person who holds a CDL shall be deemed to have consented to such testing as is required of him/her by any State or jurisdiction in the enforcement of ,383.51 (b) (2) (i) and '392.5 (a) (2) Consent is implied by driving a commercial motor vehicle. Refusal To Submit Any driver who refuses to submit to any drug or alcohol test required by this Policy will be immediately removed from service and prohibited from performing or continuing to perform a safety-sensitive function. Employees will also be subject to any disciplinary action outlined in this Policy. For purposes of this Policy, "refusal to submit" to an alcohol or controlled substances test will include: Failing to provide adequate breath for alcohol testing, without a valid medical explanation after a driver has received notice of a required breath test; Failing to provide an adequate urine sample for controlled substances testing, without a genuine inability to provide a specimen (as determined by a medical evaluation), after a driver has received notice of a required urine test; Engaging in conduct that clearly obstructs the testing process, including the failure or refusal to sign any document or form required under this Policy or by any party authorized to carry out testing under this Policy; and . Engaging in any conduct that creates reason to believe that a urine specimen has been altered, substituted or adulterated for the purpose of affecting the validity or accuracy of a controlled substance test result. A driver may not refuse to submit to the following alcohol or controlled substance tests: post-accident; random; reasonable suspicion; and follow-up. lf any of these tests are refused, the driver will not be allowed to perform or continue to perform safety-sensitive fu nctions. a a a 2B On-Duty Time All time spent providing a breath sample or urine specimen, including travel time to and from a collection site, in order to submit to any testing required under this Policy will be considered "on-duty" time. ln addition, responsibility for the expense of any drug or alcohol test required under this Policy will be as follows: Testing Circumstance Expense Company Driver 1. Pre-emolovment X 2. Pre-duty X 3. Post-accident X 4. Random X 5 Reasonable Suspicion X 6. Return-to-dutv X 7. Follow-up X 8. Retest X Testing Methodology All alcohol and controlled substances testing methodology and procedures will be established by the US Department of Transportation, Federal Motor Carrier Safety Regulations (Part 40) and will be considered the recommended method of testing for this Policy. Alcohol Testingo The Alcohol Testing Site The medical facility utilized for testing purposes will use an alcohol testing site that affords visual and aural privacy to the individual being tested sufficient to prevent unauthorized persons from seeing or hearing test results. This site will have available all of the necessary equipment, personnel and materials for breath testing, and may include the use of a mobile collection facility. The alcohol testing site will be secure and no unauthorized persons will be permitted access to it at any time when testing is being conducted or when the evidential breath testing device (EBT) remains unsecured. Alcohol testing will take place at the location designated on APPENDIX F - AUTHORIZED MEDICAL FACILITIES/COLLECTION S/IES or other approved medical testing facilities that provide services required by this Policy. a ln unusual circumstances (e.9., when it is essential to conduct a test outdoors at the scene of an accident), a test may be conducted at a place other than the above, but Visu-Sewer or the breath alcohol 29 a a technician (BAT) will ensure that visual and aural privacy will be provided to the greatest extent practicable. A BAT will supervise only one employee's use of the EBT at a time and will not leave the alcohol testing site while the preparations for testing and testing of a given employee are in progress. The above requirements also apply to the use of non-evidential alcohol screening devices by screening test technicians (STT). The Breath AlcoholTesting Form The medical facility will use a Breath Alcohol Testing Form prescribed by the Department of Transportation for both EBTs and non-evidential alcohol screening devices. This form will not be modified or revised, except that a form directly generated by an EBT may omit the space for affixing a separate printed result to the form. Transmission Of Test Results The BAT will transmit all results in a confidential manner to the individual(s) designated below, who will be responsible for any communications with the BAT concerning alcohol testing and test results and for confidentially receiving and handling alcohol testing results on behalf of Visu-Sewer: Wisconsin Representative(s): Mike Frailing, John Nelson, Alex Rossebo Telephone : (262) 695-2340 M i n nesota Representative(s): Brian Baumann, Rick Lymer Telephone: (763) 252-0004 Transmission of test results to Visu-Sewer's representative may be in writing (the employer copy (Copy 1) of the Breath Alcohol Testing Form), in person or by telephone or electronic means, but the BAT will ensure that any test results requiring the employer to prevent an employee from performing or continuing to perform a safety-sensitive function will be transmitted immediately. lf the initial transmission is not in writing (e.9., by telephone), the employer will verify the identity of the BAT providing the information through voice recognition, code word or call back (to BAT). lf the initial transmission is not in writing, the BAT will follow-up by providing the employer with its copy of the Breath Alcohol Testing Form, which will be treated as a confidential record under this Policy. ?o a a Refusal To Test And Uncompleted Tests ln the event an employee refuses to complete and sign the Breath AlcoholTesting Form, refuses to provide a breath sample, or otherwise fails to cooperate with the collection process in a way that prevents the completion of the test, the BAT or STT will record such conduct in the "Remarks" section of the Form, terminate the testing process and promptly notify Visu-Sewer. Any such conduct will constitute a refusal to test. All employees are expected to exercise good faith and cooperate during the collection process. Failure to do so will subject the employee to disciplinary action, up to and including discharge, independent and regardless of the results of any subsequent test. lf an initial or confirmation test cannot be completed for reasons other than a refusal by the employee, or if an event occurs that would invalidate the test, the BAT or STT will, if practicable, begin a new initial or confirmation test, as applicable, using a new Breath Alcohol Testing Form with a new sequential test number. Action On Positive Result ln the event a confirmatory evidential breath test yields a result indicating an alcohol concentration level of .02 or greater, the individual tested will be immediately removed from the performance of any safety-sensitive function and prohibited from operating a personal or other motor vehicle. That individual will also be responsible for arranging appropriate transportation home or back to the workplace (if Visu-Sewer did not transport him to the testing site). lf the individual refuses to comply and continues to attempt to operate a motor vehicle, Visu-Sewer, collection personnel and/or BAT will take appropriate measures to discourage the individual from doing so, including contacting local law enforcement officials. Any individualwho fails to cooperate with any of the above procedures will also be subject to disciplinary action, up to and including discharge. a Controlled Substance Testing. AppropriateLaboratory All urine specimens to be tested for the presence of controlled substances will be analyzed by a laboratory certified under the DHHS Mandatory Guidelines for Federal Workplace Drug Testing Programs. All drug tests required by Visu-Sewer will therefore be shipped for analysis to the laboratory listed below: Laboratory: Address: Noble Diagnostics 19525 Janacek Court Brookfield, Wl 53045 (262) 957-1 968 31 Telephone: or Laboratory: Address: Telephone: Account #: ACL Laboratories 8901 W. Lincoln Avenue West Allis, Wl 53227-0901 800-877-7016 A5228 999 a a lnitial Screen All urine specimens will be initially tested for the use of controlled substances by an immunoassay screen, which will eliminate negative urine specimens from further consideration. Any positive test results in an initial test will be subject to confirmation through an additional, more precise and accurate testing methodology. The cut-off levels set forth below will be used for the initial screening of specimens to determine whether they are negative for the following drugs: Marijuana metabolites - 50 ng/ml Cocaine metabolites - 300 ng/ml Opiate metabolites - 2000 ng/ml Phencyclidine - 25 ng/ml Amphetamines - 1,000 ng/ml These cutoff levels are subject to change by the Department of Health and Human Services as advances in technology or other considerations warrant identification of these substances at other concentrations. Confirmatory Tests Any urine specimen identified as positive on the initial test screen will be confirmed by a second analytical procedure independent from the initial test and which uses a different chemical technique and procedure. Gas chromatography/mass spectrometry will be used to confirm initial positive test results. The cut-off levels set forth below will be used to establish the existence of a "confirmed positive" test result: Marijuana metabolites - 15 ng/ml (delta 9tetrahyd rocan nabinol-9- carboxylic acid) Cocaine metabolites - 150 ng/ml (benzoylecgonine) 32 a Opiates Codeine - 2000 ng/ml Morphine - 2000 ng/ml O-Acetylmorphine - 10 ngiml (Test for 6-AM when morphine concentration exceeds 2,000 ng/nl) Phencyclidine - 25 ng/ml Amphetamines Amphetamine - 500 ng/ml Methamphetamine - 500 ng/ml (specimen must also contain amphetamine at a concentration of 200 ngiml. or greater) These cutoff levels are subject to change by the Department of Health and Human Services as advances in technology or other considerations warrant identification of these substances at other concentrations. Adulteration Where appropriate, the laboratory will also analyze the specimen for the presence of adulterants. ln the event the laboratory has reason to believe a specimen has been adultered, the laboratory shall report the result to the MRO. Laboratory Reporting Of Test Results Before the laboratory reports any test result, it will first review the results of the initial test, confirmatory test or any relevant quality control data to certify that the test result is accurate. The laboratory will then report the test results to Visu-Sewer's medical review officer ("MRO") within five (5) working days after the receipt of the specimen and will forward the MRO the original urine custody and control forms. The laboratory will not report test results to any MRO with whom it may be construed as a potential conflict of interest or from whom it may derive any financial benefit by the employer's use of the same. Any specimen which was negative on an initial or confirmatory test will be reported as negative. The only specimens reported as positive will be those which have been confirmed as positive through gas chromatography/mass spectrometry. Test results will not be reported verbally or by telephone and the laboratory will not report any test results directly to Visu-Sewer, but only to its MRO. The laboratory and Visu-Sewer will ensure that the data transmission is confidential and will secure and limit access to its data transmission storage and retrieval system. a 33 a a a The MRO may request from the laboratory and the laboratory will provide quantification of test results. The MRO will then report to Visu- Sewer whether the test is positive or negative and, if positive, the identity of the drug(s) for which there was a positive result. The MRO will not, however, disclose the quantification of test results to Visu- Sewer unless disclosure of the same to the employer, employee or decision-maker is necessary in a lawsuit, grievance or other proceeding initiated by or on behalf of the employee arising from a verified positive drug test. The laboratory will also provide the employer or its agent with a statistical summary of the testing program, which will not include any personal identifying information, as required by any applicable regulation. Designated Collection Sites The facilities listed on APPENDIX F - AUTHORIZED MEDICAL FACILITIES/COLLECTION S/IES or any medical facility with approved collection sites which have the personnel, materials, equipment, facilities and supervision necessary to provide for the collection, security, temporary storage and shipping of urine specimens to an appropriate laboratory for testing: A designated collection site may be any suitable location where a specimen can be collected in compliance with 49 CFR Part 40, including a properly equipped mobile facility. Any such site shall be a location having an enclosure within which private urination can occur, a toilet for completion of urination (unless a single-use collector is used with sufficient capacity to contain the void), and a suitable clean surface for writing. The site must also have a source of water for washing hands, which, if practicable, should be external to the enclosure where urination occurs. Security Any designated collection site shall have in place procedures designed to prevent unauthorized access which could compromise the integrity of the collection process or the specimen. Ghain Of Custody And Gollection Control To the maximum extent possible, collection site personnel shall keep the individual's specimen bottle within sight both before and after the individual has urinated. After the specimen is collected, it shall be properly sealed and labeled. The chain-of-custody block on the Urine Custody and Control Form shall be executed by authorized personnel upon receipt of the specimen. This form shall be used for maintaining control and accountability of each specimen from the point of 34 a a o a collection to final disposition of the specimen lndividual Privacy Collection procedures shall allow urine specimens to be provided by the individual in private, unless there is reason to believe that the individual may alter or substitute the specimen. An employee may also be required to provide a urine specimen under direct observation in the event specimen adulteration is suspected. However, a higher-level supervisor of the collection site person, or a designated employer representative, shall review and concur in advance with any decision by a collection site person to obtain a specimen under the direct observation of a same gender collection site person based upon the circumstances described above. lf the sample is being collected from an employee in need of medical attention (e.9., as part of post-accident test given in an emergency medicalfacility), necessary medical attention shall not be delayed in order to collect the specimen. Specimen lntegrity And ldentity Visu-Sewer, the employee and the collection site shall take appropriate precautions to preserve the integrity and identity of the urine specimen by ensuring that it is not adulterated or diluted during the collection procedure and that the urine specimen tested is that of the person from whom it was collected. Collection site personnel will be responsible for maintaining the integrity of the specimen collection and transfer process, but employees are expected to cooperate with collection site personnel and to exercise good faith in conjunction with the specimen collection procedures. Split Sample Procedures Visu-Sewer will use a split sample collection procedure. As a result, there must be a sufficient volume of each specimen to allow for it to be subdivided, secured and labeled in the presence of the tested individual and retained in a secured manner to prevent the possibility of tampering. This will allow an individual the opportunity to request a retest of the specimen by an appropriate laboratory in accordance this Policy. Transportation To Laboratory Collection site personnel shall arrange to ship the collected specimens to the drug testing laboratory. The specimens shall be placed in a container designed to minimize the possibility of damage during shipment (e.9., specimen boxes and/or padded mailers); and those containers shall be securely sealed to eliminate the possibility of 35 a a undetected tampering with the specimen and/or the form. On the tape sealing the container, the collection site person shall sign and enter the date specimens were sealed in the containers for shipment. The collection site person shall ensure that the chain of custody documentation is enclosed in each container sealed for shipment to the drug testing laboratory. Since specimens and documentation are sealed in shipping containers that would indicate any tampering during transit and couriers, express carriers, etc. do not have access to the chain of custody forms, this Policy does not require that such personnel document chain of custody for the shipping container during transit. This Policy also does not require that there be a chain of custody entry when a specimen sealed in a shipping container is put into or taken out of secure storage at the collection site prior to pickup by such personnel. This means that the chain of custody is not broken, and a test will not be canceled, merely because such individuals have not documented their participation in the chain of custody or because the chain of custody does not contain entries related to putting the specimen into or removing it from secure temporary storage at the collection site. Failure To Cooperate Any employee required to provide a urine sample will be expected to sign a consent or release form authorizing the collection of the specimen, analysis of the specimen for designated controlled substances, and release of the results to the employer. The employee will not be required to waive liability with respect to negligence on the part of any person participating in the collection, handling or analysis of the specimen or to indemnify any person for the negligence of others. lf the employee refuses to cooperate during the collection process (e.9., refusal to provide a complete specimen, complete paperwork, initial specimen), the collection site person will inform Visu-Sewer's representative and document the employee's conduct on the Urine Custody and Control Form. Employees are expected to exercise good faith and cooperate during the collection process and failure to do so will subject the employee to disciplinary action, up to and including discharge, independent and regardless of the results of any subsequent drug test. Controlled Substance Test Results All confirmed positive and negative test results will be reported by the laboratory to a medical review officer (MRO) before they are communicated to Visu-Sewer. The MRO will be a licensed physician with knowledge of substance abuse disorders who will review and 36 MRO: Address interpret positive test results from the laboratory. The MRO willalso review the chain of custody to ensure that it is sufficient and complete on its face and may request quantification of the test results from the lab. ln addition, the MRO will conduct an administrative review of all negative test results prior to their transmission to Visu-Sewer. Visu- Sewer's MRO is: Telephone Noble Diagnostics - Kevin B. Edwards, M.D 19525 Janacek Court Suite 103 Brookfield, Wl 53045 262-957 -1967 Fax: 262-784-0188 The function of the MRO is to explore possible alternative medical explanations for any positive test results. Before a final decision to verify a positive test result is made, the MRO will therefore conduct a medical interview with the individual, whether in person or over the telephone, and give him/her the opportunity to discuss the positive test result. The MRO may also review the individual's medical history and any other relevant biomedical factors, as well as medical records that may relate to a lawfully prescribed medication. Results of urine tests not obtained or processed in accordance with this procedure will not be considered. ln the event of a confirmed positive test result, the MRO will contact the individual directly, on a confidential basis, to determine whether the employee wishes to discuss the test result. A staff person under the MRO's supervision may make the initial contact and a medically licensed or certified staff person may gather information from the employee. Except as provided below, the MRO will talk directly with the employee before verifying a test as positive. lf, after making and documenting all reasonable efforts to contact the individual, the MRO is unable to reach the individual directly, the MRO will advise Visu-Sewer that he/she has made all reasonable efforts to contact the driver. Within 24 hours or prior to dispatching the driver, Visu-Sewer will make reasonable efforts to contact the driver and request him/her to contact and discuss the results of the drug test with the MRO, regardless of that driver's employment status at the time. Visu-Sewer will then immediately notify the MRO that the driver has been advised to contact him/her within 24 hours. lf this notification procedure becomes necessary, Visu-Sewer will ensure, to the maximum extent practicable that the requirement that the employee contact the MRO is held in confidence. lf, after making all reasonable efforts Visu-Sewer is still unable to contact the employee, it will terminate the employee from employment. The MRO will be authorized to verify a test as positive without having communicated directly with a driver about the results: lf the driver expressly declines the opportunity to discuss the test; or lf, within five days after a documented contact by the designated employer representative instructing the driver to contact the MRO, the driver has not done so. ln the event the MRO reports a positive test result to Visu-Sewer without having discussed it with the driver, the MRO will document his efforts to contact the driver, along with his/her contacts with Visu- Sewer's designated representative. lf a test is verified as positive because of an employee's failure to contact the MRO, the employee will be given an opportunity to provide the MRO with evidence establishing that a serious illness, injury or other circumstance unavoidably prevented him/her from timely contacting the MRO. The MRO may, on the basis of that information, reopen the verification and allow the employee to present information concerning a legitimate explanation for the confirmed positive test. lf the MRO concludes that there is a legitimate explanation, the MRO will declare the test to be negative. Before the MRO verifies a confirmed positive result for opiates, he shall determine that there is clinical evidence, in addition to the urine test, of unauthorized use of any opium, opiate or opium derivative (e.g morphine/codeine). This requirement will not apply if the GC/MS confirmation test for opiates confirms the presence of 6- monocetylmorphine. ln the event a question arises as to the validity or accuracy of a positive test result, the MRO will be authorized to order a reanalysis of the original sample at the same laboratory or an alternative laboratory certified in accordance with DHHS guidelines. However, only the MRO may authorize such a reanalysis, and such a reanalysis may take place only at laboratories certified by DHHS. lf the reanalysis fails to reconfirm the presence of the drug or drug metabolite, the MRO shall cancel the test and report the cancellation and the reasons for it to the DOT, the employer and the employee. When appropriate, the MRO will also receive specific consultation from the laboratory concerning the drug test results as requested by Visu-Sewer. The MRO will also notify each employee who has a verified positive ?R a a test that he/she has 72 hours in which to request a test of the split specimen. lf the employee requests an analysis of the split specimen within 72 hours of such notice, the MRO will direct, in writing, the laboratory to provide the split specimen to another DHHS-certified laboratory for analysis. The employee will not be allowed to request a reanalysis of the primary specimen and any retest requested by the employee will be at the employee's expense. lf the analysis of the split specimen fails to reconfirm the presence of the drug(s) or drug metabolite(s) found in the primary specimen, or if the split specimen is unavailable, inadequate for testing, or untestable, the MRO will cancel the test and report the cancellation and the reasons for it to the DOT, the employer and the employee. However, because some analytes deteriorate or are lost during freezing andior storage, quantitation for a retest is not subject to a specific cutoff requirement, but must provide data sufficient to confirm the presence of the drug or metabolite. lf an employee has not contacted the MRO within 72 hours, the employee may present the MRO with information documenting that serious illness, injury, inability to contact the MRO, lack of actual notice of the verified positive test, or other circumstances unavoidably prevented the employee from timely contacting the MRO. lf the MRO concludes that there is a legitimate explanation for the employee's failure to contact'him/her within 72 hours, the MRO will direct that analysis of the split specimen be performed. ln the event the MRO receives a laboratory report which indicates the possibility of adulteration, the MRO shall review and interpret the laboratory report as follows: Specific gravity <1.003 and creatinine <0.2 g/L - The MRO will report the laboratory findings (including negative result or cancelled test) to Visu-Sewer. Visu-Sewer may require the next specimen submitted by the donor to be collected under direct observation. However, a dilute specimen (SG <1.003 and creatinine <0.2 glL) will not be reasonable suspicion/cause to require the donor to submit to another specimen collection. Specimen not suitable for testing - The MRO will first discuss the test result with the laboratory forensic toxicologist to obtain more specific information about the analysis. The MRO will then contact the donor and inform him/her that the specimen was not suitable for testing and will inquire as to medications (e.9. non-steroidal anti-inflammatory agents) or other medical explanations for the specimen's unsuitability, lf no acceptable 39 a explanation for the "unsuitability" is provided, the MRO will inform the donor that another specimen will be collected under direct observation. The MRO will also report the result to the employer and inform the employer that another collection under direct observation will be required. lf there is an acceptable explanation for the "unsuitability," the MRO will report the specimen as cancelled. Specimen adultered - The MRO will report the result as "specimen adulterated" to Visu-Sewer and inform Visu-Sewer that the laboratory finding constitutes a "refusal to test" under this Policy. Disclosure of lnformation To Third Parties The MRO will not reveal individual test results to anyone unless he or she has been presented with a written authorization from the tested employee. The MRO, may, however, reveal to Visu-Sewer, without an authorization, relevant employee qualification information which indicates whether the employee has tested positive for a controlled substance. Except as provided below, the MRO will not disclose to any third party medical information provided by the individual to him/her as a part of the testing verification process. However, the MRO may disclose such information to the employer, Federal agency or a physician responsible for determining the medical qualification of the employee under an applicable DOT regulation, as applicable, only if - An applicable DOT regulation permits or requires such disclosure; ln the MRO's reasonable medicaljudgment, the information could result in the employee being determined to be medically unqualified under a DOT rule; or ln the MRO's reasonable medicaljudgment, in a situation in which there is no DOT rule establishing physical qualification standards applicable to the employee, the information indicates that continued performance by the employee of his or her safety-sensitive function could pose a significant safety risk. Before obtaining medical information from the employee as part of the verification process, the MRO will advise the employee that the information may be disclosed to third parties as provided above and of the identity of any parties to whom the information may be disclosed. lf the MRO, after completing his review, verifies a positive test result, 40 a he shall contact company officials, who will take appropriate action and/or refer the employee to the employer's employee assistance or rehabilitation program. lf the MRO determines that there is a legitimate medical explanation for the positive test result, he/she will report the results to the employer as negative. He/she will also report as negative any test result that is not supported by sufficient quality control, inspection reports or other scientific data. The MRO may report to the employer using any communications device, but in all instances will foruvard a signed, written notification within three business days of completion of the process. This written report will contain the following information: That the controlled substances test being reported was in accordance with 49 CFR Part 40; The name of the individual for whom the test results are being reported; The type of test indicated on the custody and control form (i.e. random, post-accident, etc.); The date and location of the test collection; The identities of the persons or entities performing the collection, analysis of the specimens and serving as the medical review officer for the specific test; The verified positive results of a controlled substances test, either positive or negative, and if positive, the identity of the controlled substance(s) for which the test was verified positive. The MRO will maintain all dated records and notifications, identified by individual, for a minimum of five years for verified positive controlled substances test results and a minimum of one year for negative and canceled controlled substances test results. No person may obtain the individual controlled substances test results retained by an MRO nor may the MRO release the individual controlled substances test results of any driver to any person, without first obtaining a specific, written authorization from the tested driver. However, an MRO will not be prohibited from releasing, to the employer or to officials of the Secretary of Transportation, any DOT agency, or any State or local officials with regulatory authority over the a a a o a a 4I a controlled substances testing program under Part 382, the information delineated above. Notification of Test Results Any prospective employee requesting the results of a pre-employment drug test will be provided with those results within sixty (60) days of being notified of the disposition of his/her job application. a Visu-Sewer will notify any driver who tests positive in a pre-duty, random, post-accident or reasonable suspicion drug test of those results, along with the identity of the controlled substance(s) verified as positive. ln the event visu-sewer receives notification of a positive test resurt while any driver is in service, Visu-sewer will make reasonable efforts to remove the driver from service, wherever the driver may be located. ln the event a driver is removed from service due to a positive test result, the driver will be required to arrange for transportation home, at his own expense. Confidentiality and Recordkeeping Visu-Sewer will maintain all records generated under this Policy in a secure manner so that disclosure to unauthorized persons does not occur. As a result, the results of any tests administered under this Policy and/or any other information generated pursuant to this Policy will not be disclosed or released to anyone without the express written consent of the employee, except where otheruvise required or authorized by law. ln addition, visu-Sewer's contract with its designated laboratory requires it to maintain all employee test records in confidence. However, the laboratory or Visu-Sewer may disclose information required to be maintained under this Policy pertaining to a driver, the employer or the decision-maker in a lawsuit, grievance, or other proceeding initiated by or on behalf of the individual, and arising from the results of an alcohol and/or controlled substance test administered under this Policy, or from the employer's determination that the driver engaged in conduct prohibited by this Policy (including, but not limited to, a worker's compensation, unemproyment compensation, or other proceeding relating to a benefit sought by the driver.) Upon written request by any driver, Visu-sewer will prompfly provide copies of any records pertaining to the driver's use of alcohol or controlled substances, including any records pertaining to his or her alcohol or controlled substances tests. Access to a driver's records will not be contingent upon payment for records other than those specifically requested. Records will be maintained in a secure location with controlled access. 42 Retention of records will be for a period of five year, two years, one year, indefinite period based upon the Federal Motor Carrier Regulations, Subpart D - Handling of Test Results, Record of Retention and Confidentially '382.401 Retention of records. Specific types of records shall be maintained as detailed in the Federal Motor Carriers Regulations. The type or records may include: records related to the collection process, records related to the driver's test results, records related to other violations of part '382, records related to evaluations, records related to education and training, administrative records related to alcohol and controlled substances testing. All records will be maintained as required and shall be made available for inspection at Visu-Sewer, lnc., W230 N4855 Betker Road, Pewaukee, Wl 53072; Visu-Sewer, lnc., 3155 104th Lane NE, Blaine, MN 55449 orVisu- Sewer, lnc., 1065 15th Street SW, Mason City, lA 50401 within 2 business days after request has been made by an authorized representative of the Federal Highway Administration. Visu-Sewer will also permit access to all facilities utilized in complying with the requirements of 49 CFR Part 382 to the Secretary of Transportation, any DOT agency, or any State or local officials with regulatory authority over the employer or any of its drivers. Visu-Sewer will also make available copies of all results for employer alcohol and/or controlled substances testing conducted under this Policy and any other information pertaining to the employer's alcohol misuse and/or controlled substances use prevention program, when requested by the Secretary of Transportation, any DOT agency, or any State or local officials with regulatory authority over the employer or any of its drivers. When requested by the National Transportation Safety Board as part of an accident investigation, Visu-Sewer will disclose information related to the employer's administration of a post- accident alcohol and/or controlled substance test administered following the accident under investigation. Visu-Sewer may disclose information required to be maintained under this part pertaining to a driver, the decision-maker in a lawsuit, grievance, or other proceeding initiated by or on behalf of the individual, and arising from the results of an alcohol and/or controlled substance test administered under this part, or from the employer's determination that the driver engaged in conduct prohibited by subpart B of this part (including, but not limited to, a worker's compensation, unemployment compensation, or other proceeding relating to a benefit sought by the driver.) Records will also be made available to an identified person or a subsequent employer upon receipt of a written request from a driver, but only as expressly authorized and directed by the terms of the driver's written consent. 43 a a a The subsequent release of such information by the person receiving it will be permitted only in accordance with the terms of the employee's consent. Em ployee Assistance Program All employees subject to this Policy will be provided with educational materials explaining the requirements of the regulations and our policies and procedures for meeting them. ln addition, employees will be provided with information concerning the effects of alcohol and controlled substances use on an individual's health, work, and personal life; signs and symptoms of an alcohol or a controlled substances problem (the driver's or a co-worker's); and available methods of intervening when an alcohol or a controlled substances problem is suspected, including confrontation, referral to any employee assistance program and/or referral to management. Copies of the above materials and this Policy will be distributed to each driver prior to the start of alcohol and controlled substances testing required herein and to each driver subsequently hired or transferred into a position requiring the performance of a safety-sensitive function covered by this Policy. Each driver who receives a copy of these materials will be required to sign a statement certifying that he or she has received a copy of the same. Visu- Sewer will retain the original of the signed certificate and will provide a copy to the driver, if requested (APPENDIX D - ACKNOWLEDGMENT OF RECEIPT AND REVIE\TV). We will also provide written notice to representatives of employee organizations as to the availability of this information, if applicable. Supervisory Training Any individual designated to determine whether reasonable suspicion exists to require a covered employee to undergo a drug or alcohol test under this Policy will be required to receive at least 60 minutes of training on alcohol misuse and 60 minutes of training on controlled substance use. This training will cover the physical, behavioral, speech and performance indicators of probable alcohol misuse and use of controlled substances. Referral, Evaluation And Treatment Any employee who engages in conduct in violation of this Policy will be provided with information about the resources available for evaluating and resolving problems associated with the misuse of alcohol and use of controlled substances, including the names, addresses, and telephone numbers of substance abuse professionals and counseling and treatment programs. Any employee who engages in conduct prohibited by this Policy will be required to undergo an evaluation by an appropriate substance abuse professional, who will determine what, if any, assistance the employee may need in resolving problems associated with alcohol misuse and controlled 44 substances use. This requirement will apply regardless of whether such conduct is discovered as a result of a positive drug or alcohol test, independent employer knowledge or a voluntary admission by the employee Any employee recommended for further assistance by a substance abuse professional will be afforded the opportunity to take a medical leave of absence in order to undergo any recommended treatment. Any such treatment will be at the employee's expense, unless coverage for the same is provided by any otherwise applicable health insurance plan. However, employees who violate this Policy will only be provided with this leave of absence opportunity one time. Any employee who desires to take a leave of absence in order to participate in any recommended treatment program will be expected to follow normal procedures for requesting a medical leave of absence. The employee will also be required to admit himself/herself into any prescribed program and actively participate in the same. Accordingly, proof of admission into the program, regular attendance and "drug/alcohol- free" participation will be required. Visu-Sewer will also require participation in any recommended or prescribed aftercare or similar follow-up treatment. Failure to participate in any such prescribed program or failure to attend any scheduled after-care or follow-up sessions will disqualify the individual from further employment. Under no circumstances will an employee be eligible for a leave of absence in order to obtain assistance recommended by a substance abuse professional if the SAP has referred the driver to his/her private practice or to a person or organization from which the SAP receives remuneration, or in which the SAP has a financial interest. This does not prohibit a substance abuse professional from referring a driver for assistance provided throughc A public agency, such as a State, county, or municipality; Visu-Sewer or a person under contract to provide treatment for alcohol or controlled substance problems on behalf of Visu-Sewer; The sole source of therapeutically appropriate treatment under the driver's health insurance program; or The sole source of therapeutically appropriate treatment reasonably accessible to the driver. a a a a o Return To Duty Before a driver who has engaged in any conduct prohibited by this Policy will be allowed to return to duty to perform a safety-sensitive function, he/she must first undergo a return-to-duty alcohol test with a result indicating an alcohol concentration of less than 0.02, tf the conduct involved alcohol, or a controlled substances test with a verified negative result, if the conduct 45 involved a controlled substance. Visu-Sewer may direct the driver to undergo return{o-duty and follow-up testing for both alcohol and controlled substances, if the substance abuse professional determines that return-to- duty and follow-up testing for both alcohol and controlled substances is necessary for that particular driver. Before returning to work, any driver identified by a substance abuse professional as being in need of assistance in resolving problems associated with alcohol misuse or controlled substances use must also: Be evaluated by a substance abuse professional to determine whether the driver has properly followed any prescribed rehabilitation program; and Be subject to unannounced follow-up alcohol and controlled substances tests administered by Visu-Sewer following the driver's return to duty. The number and frequency of which will be determined by the SAP and consist of at least six tests in the first 12 months following the driver's return to duty. Follow-up testing will not exceed 60 months from the date of the driver's return to duty and may be terminated at any time after the first six tests have been administered, if the SAP determines such testing is no longer necessary. A follow-up test for alcohol will only be required when the driver is performing a safety-sensitive function or just before or after the performance of any such function. Discipline ln addition to the removal from safety-sensitive functions required by the Federal Motor Carrier Safety Regulations, Visu-Sewer will take disciplinary action as detailed in this Controlled Substances/Alcohol Policy. Recordkeeping And Reporting Visu-Sewer will maintain records relating to this Policy in a secure location with controlled access. All records required by this Policy will be maintained as required by 49 CFR '390.31 and made available for inspection at Visu- Sewer within 2 business days after a request has been made by an authorized representative of the Federal Highway Administration. Reporting Requirements (Management lnformation System) lf requested by the FHWA, Visu-Sewer will prepare and maintain an annual calendar year summary of the results of all alcohol and controlled substances testing performed under this Policy. This summary will contain all of the information required by49 CFR '382. ffi@). However, if Visu-Sewer's annual calendar year summary contains only negative controlled substance test results, alcohol screening test results of less than 0.02, and no other violations of this Policy, it will have the option of preparing an"EZ" annual summary containing the information required in 49 CFR '382.403(d). a a a o o 46 ln the event a consortium prepares an annual calendar year Summary and report on behalf of Visu-Sewer, a representative of Visu-Sewer will be required to sign and submit the report and will remain responsible for ensuring the accuracy and timeliness of each report prepared on its behalf by the consortium. Consortium means an entity, including a group or association of employers or contractors, that provides alcohol or controlled substances testing as required by this part, or other DOT alcohol or controlled substances testing rules, and that acts on behalf of the employers. lf Visu-Sewer is subject to more than one DOT agency alcohol or controlled substances rule it will identify each driver covered by the regulations of more than one DOT agency. The identification will be by the total number of covered functions. Prior to conducting any alcohol or controlled substances test on a driver subject to the rules of more than one DOT agency, Visu- Sewer will determine which DOT agency rule or rules authorizes or requires the test. The test result information will be directed to the appropriate DOT agency or agencies. 41 THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK 4B APPLICANT NOTIFICATION OF VISU.SEWER'S CONTROLLED S CES/ALCOHOL POLICY The information presented below is a summary of Visu-Sewer's Controlled Substances/Alcohol Policy. A complete copy of Visu-Sewer's Controlled Substances/Alcohol Policy will be provided to the applicant upon request. Policv Visu-Sewer prohibits employee use, possession, purchase, manufacture, sale, transfer, distribution, or dispensing of illegal substances at any time; use of alcohol on the job, and use of legal drugs or alcohol that would impair the employee's ability to work. Statement Visu-Sewer has a responsibility to provide a safe and healthy workplace for its employees. The Company recognizes that the use and/or abuse of illegal/legal drugs and/or alcohol can have a significant impact on the workplace in terms of safety. Visu-Sewer has established the Controlled Substances/Alcohol Policy to protect the safety of its employees from those individuals who use or are impaired by drugs and/or alcohol on the job. lmplementation of Proqrams To demonstrate Visu-Sewer's commitment to enforcing the Policy, Visu-Sewer has established and implemented a detection program to ensure compliance with the Controlled Substances/Alcohol Policy. Visu- Sewer expects that all employees will fully and willingly participate in the programs with the knowledge that a safe, healthful and productive work environment is to the benefit of all. Detection Prooram The detection program establishes procedures to provide compliance with the Policy Tests Required Drug and/or alcohol testing is required as a part of pre-placement examination. DOT physicals, required for employment as a driver of company commercial motor vehicles, will include drug and alcohol testing. Consent To Testinq Prospective employees must submit to pre-employment drug and alcohol testing. Applicants will be required to complete and sign a form by which he/she consents to and authorizes testing and disclosure of test results to Visu-Sewer. As established by the U.S. Department of Transportation, Federal Highway Administration, Federal Motor Carrier Safety Regulations, implied consent to alcohol testing '383.72 states that any person who holds a CDL shall be deemed to have consented to such testing as is required of him/her by any State or jurisdiction in the enforcement of '383.51 (b) (2) (i) and '392.5 (a) (2). Consent is implied by driving a commercial motor vehicle. Conditions Of Emplovment Visu-Sewer will enforce this Policy as a condition of employment. Employees will abide by the terms of this Policy as a condition of employment. Employees will be subject to drug and/or alcohol testing as set forth in this Policy. Drug and alcohol testing is mandatory for Visu-Sewer employees as a condition of employment. Any job offer is contingent upon, among other things, a negative test. Prospective employees will be notified in advance of said drug and alcohol test. lf the prospective employee refuses to submit to the drug and alcohol test, consideration for employment with Visu-Sewer will immediately cease. A prospective employee will not be allowed to begin work at Visu-Sewer until the results of the drug and alcohol test are known. lf the results of the test are positive, the prospective employee will be denied employment. APPENDIX A THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK ACKNOWLEDGMENT OF NOTIFICATION OF VISU.SEWER'S CONTROLLED SUBSTANCES/ALCOHOL POLICY I acknowledge that I have received notification of Visu-Sewer's Controlled Substances/Alcohol Policy I understand that controlled substances and/or alcohol testing is required as a part of pre-placement examinations and as a condition of employment. I consent to and authorize testing as established by the Policy. I understand that I will be notified in advance of said controlled substances and/or alcohol tests. I understand that if I refuse to submit to the controlled substances and/or alcohol test that consideration for employment will immediately cease. As a prequalification for employment, I will not be allowed to begin work at Visu-Sewer untilthe results of the controlled substances and/or alcohol test are known. lf the results of the test are positive, I will be denied employment. I acknowledge that I have had an opportunity to request a complete copy of the Policy and to ask any questions I may have about the Policy and related issues. By my signature, I acknowledge my acceptance of the terms and conditions of the Policy. Date Applicant's Printed Name: Applicant's Signature APPENDIX B THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK YSYiilu*s,jHHHf** Safety Performance History Record (DoT-Regulated Employees) S:\Accountitrg\FoRMs\Appltcationslsafety Perlomance History Record (DOT Regulatcd Employees) docx W230 N4855 Betker Drive, Pewaukee, WI 53072 262-695-2340 1-800-876-8478 FAX 262-695-2359 Step 3: Previous Employer } Complete the required information in Parts 2,3 and 4 ) Make a copy of the form for your records ) Forward the completed form back to the prospective Employer (see Part 1A) Step 4: Prospective Employer ) Complete the required information in Parts 44' and 48 ) Record receipt of form from previous employer F Retain copy in the applicant's driver qualification File ifhired, and discard temporary record retained from Step 2. Ifnot hired, retain as dictated by company policy Instructions: Step I Prospective Employee (Drive Applicant) ) Complete the required information in Part I F Sign and date where indicated in Part 1 ) Copy form for your record F Forward original to Prospective Employer Step 2: Prospective Employer ! Complete the required information in Part 1A ) Have Prospective employee sign and date the form, ifnot already done from Step I ) Make copy of the form to be set aside as a temporary record F Forward form to Previous Employer PART l: To Be Completed Bv Prospective Emplovee (Driver Applicant) I, (Printed Name) regulated hereby authorize the following previous DOT- (First, Middle, Last) Employer to release and forward all requested information contained herein concerning my safety performance history (as required by 49CFR$40.25and$391.23fortheprevious3yearsfrominc1uding: (date of application) 1. General employment information; 2. DOT-recordable accidents (as defined by 49 CFR $390.5) involving the above named driver; and 3. DOT-regulated Alcohol and Controlled Substance Testing results/information. Previous Employer: (Compmy Nm)(ComtNDy Rept5ehtative/Pteviot8 Superuisor) Address:Phone No.:Fax No. City, State, Zip Email. Applicant's Signature Today's Date Social Security Number Date of Birth Part lA: To Be Completed bv Prospective Emplover Prospective Employer: Visu-Sewer. Inc. Attention: Lindsay Golner Address:W230 N4855 Betker Drive City, State, Zip: Pewaukee. WI 53072 Phone: 262-695-2340 Fax: 262-695-2359 Email: visu-info@visu-sewer.com In compliance with 49 CFR $40.25(9) and $391.23(h), release of this information is required and must be in a written form that ensures confidentiality such as fax, email, or post mail. Send or forward information fax or email within Part 2: To Be Completed By Previous Emplover General Previous Employment Information: The named applicant was employed by us as a DOT-regulated driver (as defined by 49 CFRg390.5) from (mrr/yyyy) to (rur/yyyy)_ l. During this time, the applicant operated (please check all applicable vehicle types): Straight Truck E Semi Tractor-Trailer ! Bus/Motor Coach I Cargo Tank-Trailer I Double/Triple Trailers I Other (Specify) 2. Reason for leaving your employ: lVoluntary Resignation E Involuntary Discharge tr Lay Off ! Military or Other Leave of Absence ! Other (Specify) 3. Is the above named applicant eligible for rehire? Yes E No E Part 3: To Be Completed Bv Previous Emplover Accident History: Ifthe above named applicant was not involved in any accidents as defined by 49 CFR $390.5*, while employed by your organization check here n and go to Part 4 below: For any accidents as defined by 49 CFR$390.5*, and as listed on your required accident register (49 CFR$390. l5(b)), involving the above name applicant in the 3 years prior to the application date stated above, complete the following: Date Iocation No. of Injuries No. of Fatalities Hazmat Spill YeslNo E YesnNo ! YesnNo E l. 2. Please provide any additional information related to observations of unsafe commercial motor vehicle operation or accidents involving the applicant that were reported to you, your organization, government agencies, or insurers or retained under internal company policies: Include any additional safety performance remarks *Accident means an occutrence involving a commercial motor vehicle operating on a highway in interstate or intrastate commerce which results in: A A fatality; A Bodily injury to a person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident; or A One or more motor vehicles incurring disabling damage as a result of the accident, requiring the motor vehicles(s) to be transported away from the scene by a tow truck or other motor vehicle. Part 4: To Be Completed Bv Previous Emplover DOT-Regulated Drug and Alcohol Testing History: If the named applicant was not subject to DOT-regulated alcohol and controlled substance testing requirements while in your employ check here n, complete the bottom portion of Part 4, sign and return this form. The above named applicant was subject to DOT-regulated alcohol and controlled substance testing requirements while in your employ fi'om _ to l. Did the individual have an alcohol test with a blood alcohol concentration result of0.04 or higher? tr 2. Didthe individual tested positive or adulterated or substitute atest for controlled substances? NoE 3. Did the individual refuse to submit to a DOT-regulated alcohol or controlled substance test? No! 4. Did the individual engage in conduct prohibited by 49 CFR Part382 - Subpart B, or Part 40? NoE 5. Did the individual volunteer that he or she has an alcohol or controlled substance problem? NoE 6. If "Yes" was checked for any question l-5, did this individual complete a SAP-prescribed rehabilitation program while in your employ, including a return-to-duty and all follow up tests? Ifyes, please send documentation along with this form. Yes E No Yes E Yes D Yes ! Yes ! Yes fl No ! In answering the above questions, include any required DOT drug or alcohol testing information obtained from previous employers in the previous 3 years prior to the application date stated above. Name:Title: Desi gnated Employer Representative (if different fr om ab ove) : Company: Address: City, State, Zip _ Email:Phone:Fax: Signature:Date: Part 4A: To Be Completed Bv Prospective Emplover This form was (Check One): ! Faxed to previous employer ! Mailed n Emailed E Other By (Name and Title)T,indsav Golner Hrrmnn R Generalist Date: Part 48: To Be Completed By Prospective Employer Complete the information below when required information is obtained. Information was received from (Name and Title):Date: Received and recorded via: ! Fax n Mail E Email ! Phone E Other No responses/reply received E APPENDIX C ACKNOWLEDGMENT OF RECEIPT AND REVIEW OF VISU.SEWER'S CONTROLLED SUBSTANCES/ALCOHOL POLICY I acknowledge that I have received Visu-Sewer's Controlled Substances/Alcohol Policy. The Policy has been reviewed with me and I am familiar with the information discussed during the review. I understand that the Policy relates to my safety and terms of employment at Visu-Sewer. I agree to read the policy and to ask any questions that I may have regarding the policy. I have received training on the dangers of drug abuse in the workplace, the effects and consequences of controlled substance use on personal health, safety and the work environment, and the manifestation and behavioral changes that may indicate controlled substance use or abuse. I further acknowledge that I have had an opportunity to ask any questions I have about the Policy and related issues. I will direct any future questions regarding this Policy to Visu-Sewer's Safety Director. Answers to my questions will be given to me by the Safety Director within 24 hours of my questions. By my signature, I acknowledge the terms and conditions of the Policy and consent to testing as described and required in the Detection Program. My signature certifies my commitment to assist Visu- Sewer to enforce the Policy, my intent to comply with the Controlled Substances/Alcohol Policy and my personal commitment to remain drug-free. Employee's Printed Name Employee's Signature Management's Signature APPENDIX D THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK PREVIOUS PRE-EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT S:\Accounting\FoRMS\Applications\Previous Pre-Employment Employee Alcohol and Drug Test Statement,docx Sec. 40.25O Visu-Sewer, Inc. is required as an employer to ask you whether you have tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If you admit that you had a positive test or refused to be tested, you may not be employed by Visu-Sewer to perform safety-sensitive functions, until and unless you document successful completion of the return-to-duty process (see Sec. 40.25(bX5) and (e). As a prospective employee, you are required by Sec. 40.250) to respond to the following questions. 1)Have you ever tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years? Check One: Yes No 2)If you answered yes, can you provide/obtain proof that you have successfully completed the DOT return-to -duty requirements? Check One: Yes No I certify that the information provided on this document is true and correct. Applicant's Print Name Social Security Number DateApplicant's Signature APPENDIX E THIS PAGE HAS BEEN ]NTENTIONALLY LEFT BLANK AUTHORIZE D M E DICAL FACI LITI ES/COLLECTIO N SITES The facilities listed below or any medical facility with approved collection sites which have the personnel, materials, equipment, facilities and supervision necessary to provide for the collection, security, temporary storage and shipping of urine specimens to an appropriate laboratory for testing will be considered by Visu-Sewer as authorized collection sites. Collector's Name Address: Telephone Collector's Name: Address: Telephone Collector's Name Address: Telephone: Collector's Name Address: Concentra Medical Centers 2455 N. 124th Street Brookfield, Wl 53005 (262)782-9326 Noble Diagnostics 19525 Janacek Court Brookfield, Wl 53045 (262) 957-1968 Allina 9055 Springbrook Drive NW Coon Rapids, MN 55433 (763) 236-1210 Mercy HealthWorks Occupational Health 1501 4th Street S. W. Mason City, lA 50401 (641) 428-5244Telephone The collection site is a medical facility or other designated suitable place which may include a mobile facility where individuals present themselves for the purpose of drug or alcohol testing. The site will have available all the necessary equipment, personnel and materials for testing. The site will afford visual and aural privacy to the individual being tested and security sufficient to prevent unauthorized persons from tampering with specimens collected. ln the case of breath alcohol testing, the site should provide security sufficient to prevent unauthorized persons from seeing or hearing test results. ln compliance with the Federal Motor Carrier Regulations, a designated collection site may be any suitable location where a specimen can be collected in compliance with 49 CFR Part 40, including a properly equipped mobile facility. APPENDIX F THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK REPORT OF REASONABLE CAUSE/SUSPICION Documentation of observations must be completed within 24 hours of observations. Supervisory or company officials documenting reasonable cause/suspicion for DOT purposes musf have completed appropriate training for dete r mi ni ng re a son able c au se/su spi cion. Employee's Name Name of lndividual Witnessing and Documenting ConducUBehavior: Witness's Relationship to the Employee: Date and Time of Report Where did Reasonable Cause/Suspicion occur? Date and Time of Occurrence: Other Observers: Description of what was observed (detail specific behavior and appearance. See list on back of this form for assistance in detailing the observation and/or behavior. ltems listed may be indicated as observations by placing an X in the box provided and specific observations circled for documentation purposes.) Was an attempt made to discover the existence of an explanation other than substance abuse? . ( )Yes ( )No lf Yes, explain Were there any signs or complaints of illness or injury? ( )Yes ( )No lf Yes, explain ls employee in a "safety sensitive function"? ( )Yes ( )No lf yes, explain function Witness's Opinion: Apparent Effects of Drug/Alcohol Use ( )None ( )Slight ( )Obvious ( )Extreme Confidential information is documented in this statement. Drug or alcohol abuse information is not to be reported or repeated, under any circumstances, to anyone other than those individuals outlined in the Controlled Substances/Alcohol Policy. Documentation of the employee's conduct shall be prepared and signed by the witness within 24 hours of the observed behavior or before the results of the test are released, whichever is earlier. This form is to be submitted to the Safety Director for review and action. Signature of Witness APPENDIXG-Pagel Work Behavior Sporadic Work Performance Error ln Judgment Confusion (e.9., Difficulty ln Recalling lnstructions, Details) Difficulty ln Concentration Procrastinaiion Altered Sense of Time lmpaired Reaction Times Reduced Coordination Problems On The Job Accident Prone Decline ln Productivity Decline ln Quality lncrease ln Mistakes Difficulty in Prioritizing Carelessness Unauthorized Meetings ln Remote Work Areas Vehicle Accident lnjury O Absenteeism tr Arriving LateD Leaving EarlyD TardinessD Extended meal periods and/or breaksD Frequent absences from work areastr Unexplained Disappearance From Job With o Difficulty ln Locating Employee tr Frequent illness on the job O Excessive amount of personal telephone time . Excessive excused and unexcused absencesO High absenteeism rate for minor illnessesD Frequent Monday/Fridayabsences or absences whichO follow a pattern O Peculiar and improbable excuses for absencesO Asking to Leave Work Early For Different Reasons f, Relationships With Others D Edgy, lnitableD Oversensitive,Over-reactivetr lntolerantO SuspiciousD Blaming Otherstr lncreasedNervousnessn Avoids or Withdraws From Co-Workersd Problems in personal relationshipstr Over-Exaggerated Sense of Well-Being tr ArgumentativeO Extra TalkativeO WithdrawnO Disregard For Safely Of OthersE Exaggerated Sense of Self-lmportancetr Complaints From Co-Employeestr Problems With Authority Figuresn Combative D BehaviorCharacteristics n Walking: Stumbling, Staggering, Falling, Wobbling, Needs Support, Hesitant, Unable To Walk, Swaying, Unsteady, Holding OnD Standing: Swaying, Rigid, Unable To Stand, Sagging At Knees, Feei Wide Apart, DizzinessO Speech: Shouting, Whispering, lncoherent, Slurred, Mute, Slow, Slobbering, Rambling, Confus6d, Stuttered, Thick-Tongued, Mumbled, Mush-Mouthed, Cotton-Mouthed, Not Understandable, Fair, Good, Normal Demeanor: Cooperative, Polite, Unstable, Readily Open To Change, Suspicious, Crying, Laughing, Dangerous, Mood Swings, Over Reactions Actions: Resisting Communicaiion, Fighting, Drowsy, Hostile, Eyes: Bloodshot, Watery, Dilaied, Glassy, Droopy, Closed, Blurred Vision Face: Flushed, Pale, Sweaty Appearance/Clothing: Unruly, Messy, Dirty, Neat, Change ln Type Of Clothing, Wearing Of Chains, Roach Clips Or Oiher Drug-Related Accessories Or Objects, Having Odor, Partially Dressed, Bodily Excrement Stains On Clothing Breath: Alcoholic Order, Faint Alcoholic Order, No Alcoholic Order Breathing: lncreased Breathing Rate, Stuffy Or Runny Nose Body: Reduced Appetite, Weight Loss, Sweating, Headaches, Skin Disorders, Ulcers, Severe Dehydration, Digestive Disturbance, Hiccoughing, Vomiting, Belching Movements: Fumbling, Jerky, Slow, Normal, Nervous, Hyperactive Eating/Chewing: Gum, Candy, Mints, Other - ldentify: n Other Behavior Observations Non-work related accidents Accidents while working Deterioration in appearance Loss of interest, decrease in activities Overly Energetic Overly Alert Restlessness Anxiety Sleeplessness Paranoia Depression Listlessness Weariness Borrowing of money from others o o D D o o D o D o D o n o n o tr o o D o D 3 D D D tr o . D D n D D o o tr o n o o o o o tr APPENDIXG-Page2 POST-ACCIDENT/INJURY INSTRUCTIONS Visu-Sewer's Controlled Substances/Alcohol Policy requires each employee directly involved or whose performance contributes to an accident must submit to a drug and/or alcohol test as soon as practicable after an accident. An accident is defined as: an OSHA recordable incident, acts or omissions resulting in near misses, and accidents involving a personal injury that requires treatment at a medical care facility; incident causing personal injury to another person who requires medical treatment at a medical care facility; and/or property or vehicle damage of $1 ,000.00 or more. The Department of Labor Occupational Safety and Health Administration (OSHA) defines a recordable incident as a work-related injury or illness that results in death, loss of consciousness, days away from work, restricted work activity or job transfer, or medical treatment beyond first aid. The Federal Motor Carrier Safety Regulations require drivers of commercial motor vehicles to submit to drug and alcohol testing as soon as practicable following any accident in which a driver: 1. Was performing safety-sensitive functions with respect to the vehicle and the accident involved the loss of human life; or2. Received a citation under State or local law for a moving traffic violation arising from the accident. An "accident" is defined as an occurrence involving a commercial motor vehicle operating on a public road which results in: 1. A fatality;2. Bodily injury to a person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident or3. One or more motor vehicles incurring disabling damage as a result of the accident, requiring the vehicle to be transported away from the scene by a tow truck or other vehicle. Testing will be required in the above circumstances even if the driver involved is not at fault or if the driver's possible contribution to the accident cannot be ruled out. DRIVERS ARE STRICTLY PROHIBITED FROM USING ALCOHOL FOR EIGHT HOURS FOLLOWING AN ACCIDENT OR UNTIL THE POST-ACCIDENT TESTING REQUIREMENTS ARE CARRIED OUT, WHICHEVER OCCURS FIRST. ln order to ensure that the above requirements are met, in the event of g4y gig!g!, 4!_@gIg, are required to take the following actions: 1. Stop immediately.2. Take all necessary precaution to prevent further accident at the scene.3. Render all reasonable assistance to injured persons (movement of an injured person should not be undertaken to prevent further injury).4. Call law enforcement agency to report the accident,5. Give to any person demanding the same, the driver's name and address of Visu-Sewer, the State tag registration number of the vehicle involved, and if requested, exhibit operator's license.6. Report all details of the accident as soon as possible after its occurrence to Visu-Sewer.7. Report to nearest approved medical facility for alcohol and controlled substances testing as soon as practicable following the accident (Preferably with 2 hours after the accident and not more than 8 hours after the accident for alcohol testing and not more than 32 hours for drug testing.) Please note that these procedures do not require a driver to delay any necessary medical attention for injured people following an accident or to remain at the scene of an accident when his/her absence is necessary to obtain assistance in responding to the accident or to obtain necessary emergency medical care. FAILURE OR REFUSAL TO FOLLOW THESE INSTRUCTIONS, INCLUDING THE USE OF ALCOHOL PRIOR TO THE REQUIRED POST-ACCIDENT ALCOHOL TEST, WILL BE CONSIDERED A REFUSAL TO SUBMIT TO A TEST AND RESULT IN DISCIPLINARY ACTION. APPENDIX H THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK AUTHORIZATION FOR POST.ACCIDENT/INJ URY CONTROLLED SUBSTANCES/ALCOHOL TESTING TO Medical Testing Facility FROM: Visu-Sewer, lnc. SUBJECT: Authorization for Post-Accident Controlled Substances/AlcoholTesting Visu-Sewer, lnc. requires that all employees involved in vehicle accidents or injured in work related accidents be tested for controlled substances and/or alcohol. lf verbal authorization for the testing is required, please contact a member of Visu-Sewer's management at 800-876-8478. Billing for the tests to be performed and related services should be sent to: Visu-Sewer, lnc. W230 N4855 Betker Road Pewaukee, Wl 53072 Telephone Number: 800-876-8478 Alcohol Testing Results and Specimen Collected should be forwarded with Custody Forms to: Advanced Toxicology Network (ATN) 3560 Air Center Cove, Suite 101 Memphis, TN 38118 Telephone N um ber: 888-222-4894 Profile #1361 61 (FMCSA) ACL Laboratories 8901 W. Lincoln Avenue West Allis, Wl 53227-0901 Telephone: 800-877-7016 Account#: A5228999 Non-DOT Testing: Tests to be performed: X_51001 - 5 Panel (AR-76939) Chain of Custom Forms for non-dot collections should reference Visu-Sewer's name and address and Employers lD Number: 90489N. Federal Drug Testing: Tests to be performed: THC, Cocaine, PCP, Opiates and Amphetamines Federal Drug Testing Custody and Control Forms should reference Visu-Sewer's name and address and Employers lD Number: 90489. The MRO Name and address is: Kevin B. Edwards, M. D. Noble Diagnostics 19525 Janacek Court Suite 103 Brookfield, Wl 53045 Telephone: 262-957 -1 967 F ax: 262-7 84-0 1 88 Thank you for your assistance in performing the tests required by Visu-Sewer's Controlled Substances/Alcohol Policy. APPENDIX I THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK SPEGIMEN COLLECTION PROCEDURE INSTRUCTION/INFORMATION TO THE DONOR These procedures are designed to promote confidentiality and privacy for the employee while assuring the integrity of the specimen and the collection process. lt is imperative that, for their own protection, applicants and employees fully cooperate with the procedures. BRING ALONG A PHOTO lD. The collection site is not permitted to accept your specimen without it. ln rare instances where the employee is unable to produce lD due to injury or the like, the personal identification by a high level supervisor may be accepted. Without positive identification, the specimen collection cannot take place. O Do not prepare for the test by drinking large amounts of fluid. A diluted specimen may not be accepted by the laboratory and can be considered grounds forAwitnessingG future specimen collections. O Relax. The system has been established in the favor of the employee. You should expect to be allowed privacy and be treated with respect by the collection agent. O Upon arrival at the collection site, present a photo lD and inform the receptionist that you are making yourself available at the request of Visu-Sewer for testing. Present any documents provided by Visu-Sewer and tell him/her that you are having a drug test specimen and/or breath alcohol test. You may also request the collection agent to provide positive identification and qualifications to you. O ln an appropriate dressing area, you will be instructed to remove all outer garments and leave those, as well as all parcels, briefcases, or purses outside the collection area. You may be asked to iurn your pockets inside out. Your wallet will be reiained in a locked box and the key given to you during collection. B You will be asked to choose a container package from a box holding a number of containers. Check to see that the package is sealed. lf the package is tom or has already been opened, the container may be non-sterile or contaminated and you should ask to choose another container which is still sealed. ln the event you have been given a container by Visu-Sewer to present to the collection agent, the seal on the package must be intact to be used for the testing procedure. D You will be required to compleie and execute testing and chain of custody forms to certiry your consent to submit to tesling and that the identirying information provided on the forms is true and conect. D You will be escorted into a prepared collection area. No prior access to the collection area is allowed. D You will be asked to wash and dry your hands well. The collection agent may check your fingernails for remaining soap or other chemicals or debris. Access to running water, soap, cleaning fluids and the like will be eliminated. tr The collection agent will place blue dye in the toilet tanubowl in the collection area. D The collection agent will then escort you into the collection area which will protect your privacy with a door or a privacy partition. tr DOT requirements state that approximately 45 mls of urine be collected in one urination. lf the amount is slightly lower, it may be accepted. lf an insufficient quantity is collected, you may be asked to provide a second specimen. 3 The collection agent will then accept lhe specimen from you, ask you to wash your hands and accompany him/her to a prccessing area. D The collection agent will record lhe temperature of the specimen from the indicator on the collection bottle. This must be done within four minutes of urination. lf the temperature is not between 90 "F and 100"F, the collection agent will ask you to submit to having your oral temperature taken. lf your oral temperature and that ofthe specimen do not match, you may be asked to submit a second specimen, this time in the presence of the collection agent or his/her supervisor. E lf the temperature of the specimen is outside normal range and not confirmed by oral iemperature, if your specimen is being collected as a post-treatment monitoring specimen, or if any previous specimen produced suspicion of adulteration, you may be asked to submit a witnessed collection. Witnessed collection means that a collection agent of the same gender will accompany you into the submission area and must visually monitor lhe submission assuring that the specimen is unadulterated. D The collection agent will open your specimen container and pour off approximately 15 mls of the specimen into the split specimen container. D The collection agent will then seal the specimens with tamper proof tape and ask that you initial the specimens in at least one, often several, places. D The Chain of Custody form will be completed. You will be asked to sign your name, record your social security number and home phone number. Your signature attests to the fact that the specimen is yours, that it is fresh and unadulterated and that all information on the bottle and the documents is correct. lt gives permission for the analysis of the specimen and the conveyance of results to the MRO and employer. O The specimen and the Chain of Custody form will then be placed in a secondary container, often a shipping container and you may be asked to initial the seal on that container as well. O Collection is complete and you may go. APPENDIX J THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK Alcohol and Drug Employee's Gertified Receipt This is to certify that I have been provided educational materials required by 9382.601 and my employer's policies and procedures with respect to meeting the Part 382 requirements. The materials include detailed discussion of the following items: 1. The designated person to answer questions about the materials. Wl Office: Mike Frailing MN Office: Brian Baumann 2. The categories of drivers subject to Part 382. ALL drivers are subject to regulations. 3. Sufficient information about the safety-sensitive functions and periods of the workday that compliance is required. All loading, unloading operations, driving, and machinery operation is considered Safety Sensitive. All field employees are required to be in compliance with the regulations as outlined in the FMCSR'382 and FMCSR '40. 4. Specific information concerning prohibited driver conduct. No drug use or alcohol consumption is permitted while on duty. 5. Circumstances under which a driver will be tested. All employees are subject to: Pre-employment, Reasonable Cause, Post Accident (any accident in a company vehicle or on company time), Random, and Follow up. 6. Test procedures, driverprotection and integrityof the testingprocesses, and safeguarding the validity of the test. Please see FMCSR'382.303 Subpart D. 7. The requirement that tests are administered in accordance with Part382 All employees are subject to testing 8. An explanation of what will be considered a refusal to submit to a test and the consequences. Refusal of any test is the same as a positive result. 9. The consequences for Part382 Subpart B violations including removal from Safety-sensitive functions and Part 40, Subpart 0 procedures. TERMINATION 10. The consequences for drivers found to have an alcohol concentration of 0.02 or greater but less than 0.04. Suspension for one day as pursuant to '382.505 1 1. Information on the effectss of alcohol and controlled substances Refer to handout entitled Druq and Alcohol Testinq: Traininq and Awareness. which is issued during orientation. APPENDIX K O MarshMcLennan Agency Chris Hovden Vice President - Sureiy June 14,2024 Marsh Mclennan Agency 2725 South Moorland Road New Berlin, Wl 53151 r 920225 688l M 9205301520 chris.hovden@marshmma.com Contractor: Visu-Sewer, LLC; Visu-Sewer of lllinois, LLC; Visu-Sewer of Ohio, LLC; Visu-Sewer of Missouri, LLC; Visu-Sewer East, LLC Surety Bonding Reference To Whom lt May Concern Visu-Sewer, LLC, and its affiliated companies Visu-Sewer of lllinois, LLC; Visu-Sewer of Ohio, LLC; Visu-Sewer of Missouri, LLC and Visu-Sewer East, LLC (collectively Visu-Sewer), is a highly regarded client of Applied Surety Underwriters and Trisura lnsurance Company (Sureties). Visu-Sewer has access to a surety bond program covering single projects up to $25,000,000 with aggregate backlog support to $150,000,000. The Sureties maintain the highest degree of confidence in the reputation and management expertise of Visu-Sewer to successfully perform and complete their work. lt is the Sureties intention to support Visu-Sewer for all contract bond needs; however, any specific request for performance and payment bonds will be subject to underwriiing review of project detaiis, bond forms, contract terms, project financing and any other information pertinent to the project. Any arrangement for a bond or bonds is a matter between Visu-Sewer and the Sureties, and they assume no liability to any third parties. Applied Surety Underwriters, through affiliation with Applied Underwriters, is rated A- (Excellent) with a financial size category of Xl by A.M. Best. Trisura lnsurance Company is rated A- (Excellent) with a financial size category of lX by A.M Best. Sincerely, Christopher K. Hovden Vice President - Surety RE A business of Marsh Mclennan Marsh McLennan Agency Your future is limitless.* MAJOR PROJECTS COMPLETED IN THE LAST IHREE]IEAB9 City of Milwaukee 841 N. Broadway Milwaukee, WI 53202 Contact: Tim Thur City of La Crosse 400 La Crosse Ave. La Crosse, WI 54601 Contact: Robert Haines City of Sun Prairie 300 E. Main Street Sun Prairie, WI 53590 Contact: Jeremy Cramer City of Mason City 10 First Street NW Mason City, IA 50401 Contact: Bill Stangler Northwestern Water & Sewer District 12560 Middleton Pike Bowling Green,OH 43402 Contact: Ted Bennet (Jones & Henry) Rock River Water Reclamation District 3501 Kishwaukee Street Rockford, lL 61126 Contact: Matt Campbell City of Roseville 2660 Civlc Center Drive Roseville, MN 55113 Contact: Luke Sandstrom City of Moorhead 500 Cedar Ave. Moorhead, MN 56560 Contact: Tom Trowbridge City of Pleasant Prairie 9915 39th Avenue Pleasant Prairie, WI 53158 Contact: Paul Schafer (RA Smith Engineering) Contract Price: $1,214,000 Completion Date: Jantary 2021 Class of Work: CIPP, Point Repairs, MH Rehab Telephone: 414-286-2463 Contract Price: $789,000 Completion Date: April 2021 Class of Work: CIPP & MH Rehab Telephone: 608-788-7505 Contract Price: $263,000 Completion Date: April 2021 Class of Work: CIPP & Grouting Telephone: 608-825-073 I Contract Price: $230,367 Completion Date: Iune 2021 Class of Work: CCTV & Pipe Cleaning Telephone: 641-421-3682 Contract Price: $1,229,47 3 Completion Date: JuJy 2021 Class of Work: CCTV, Pipe Grouting, Point Repairs Telephone: 419-473-9611 Contract Price: $2,344,000 Completion Date: August 2021 Class of Work: CIPP Telephone: 815-387 -7684 Contract Price: $1,144,000 Completion Date: August 2021 Class of Work: CIPP & Grouting Telephone: 651-792-7048 Contract Price: $1,723,000 Completion Date: October 2021 Class of Work: CIPP, Point Repairs, MH Rehab Telephone: 218-299-5390 Contract Price: $2,300,000 Completion Date: October 2021 Class of Work: CIPP, Grouting, MH Rehab Telephone: 262-317 -3381 MAJOR PROJECTS COMPLETED I City of Champlin 11955 Champlin Drive Champlin, MN 55316 Contact: Emily Brown (WSB Engineers) City of Wauwatosa 7725 West North Avenue Wauwatosa, WI 53213 Contact: Megan Mclane City of Mequon 11333 N. Cedarburg Road Mequon, WI 53092 Contact: KevinDriscoll City of Mason City 10 First Street NW Mason City, IA 50401 Contact: Bill Stangler City of West Des Moines 4200 Mills Civic Parkway West Des Moines, lA 50265 Contact: Todd Allyn (AECOM) City of Casey 104 W. Sherman Street Casey, IA 50048 Contact: Jordan Kappos (V&K Engineers) City of Wisconsin Rapids 444West Grand Avenue Wisconsin Rapids, WI 54495 Contact: Nicholas Dums Coon Rapids Municipal Utilities 123 3'd Avenue Coon Rapids, IA 50058 Contact: Jordan Kappos (V&K Engineering) Village of Germantown Nl22Wl7l77 Fond du Lac Avenue Germantown, Wl 53022 Contact: Tim Zimmerman Contract Price: $597,000 Completion Date: Mar ch 2022 Class of Work: CIPP & Grouting Telephone: 615-286-8450 Contract Price: $450,000 Completion Date: Aprrl 2022 Class of Work: CCTV & Pipe Grouting Telephone: 414-83 1-5503 Contract Price: $295,000 Completion Date: May 2022 Class of Work: Grouting, Pipe Cleaning & Reaming Telephone: 262-236-2937 Contract Price: $217,000 Completion Date: Jlune 2022 Class of Work: CCTV & Pipe Cleaning Telephone: 641-421-3682 Contract Price: $546,000 Completion Date: September 2022 Class of Work: CIPP Telephone: 515-323-7921 ContractPrice: $464,000 Completion Date: November 2022 Class of Work: CIPP, MH Lining & Grouting Telephone: 515-225-8000 ContractPrice: $407,000 Completion Date: November 2022 Class of Work: CIPP Telephone: 7 15-421-8205 Contract Price: $1,993,000 Completion Date: December 2022 Class of Work: CIPP, MH Lining & Grouting Telephone: 5 l5-225-8000 Contract Price: $2,339,000 Completion Date: December 2022 Class of Work: CIPP & Manhole Rehab Telephone: 262-253-77 65 City of Fort Wayne 200 E. Beny Street Fort Wayne, IN 46802 Contact: Blake Nelson City of West Allis 1525 W. Geenfield Ave. West Allis, WI 53214 Contact: HeathBrozovich City of Moorhead 500 Center Ave. Moorehead, MN 56561 Contact: Tom Sopp City of Adrian 321 Race Street Adrian, Ml 49221 Contact: Eric Kelly City of Wauwatosa 7725 West North Avenue Wauwatosa, WI 53213 Contact: Megan Mclane City of Mason City 10 First Street NW Mason City, IA 50401 Contact: Bill Stangler City of Milwaukee 841 N Broadway Street Milwaukee, WI 53202 Contact: Zafar Yousf City of Waukesha 130 Delafield Street Waukesha, WI 53188 Contact: Chris Langemak Village of Constantine 115 White Pidgeon Street Constantine, Ml 49042 Contact: Joseph Benjamin MAJOR PROJE CTS COMPLETED IN THE LAST THREE YEARS Contract Price: $2,003,000 Completion Date: December 2022 Class of Work: CIPP & Manhole Rehab Telephone: 260-427-6050 Contract Price: $470,000 Completion Date: December 2022 Class of Work: Grouting, Pipe Cleaning & Reaming Telephone: 414-302-8376 Contract Price: $6,565,000 Completion Date: May 2023 Class of Work: CPP, Point Repairs & MH Rehab Telephone: 218-299-5390 Contract Price: $1,329,000 Completion Date: June 2023 Class of Work: CIPP & MH Rehab Telephone: 517 -264-4889 ContractPrice: $700,000 Completion Date: Jlune 2023 Class of Work: CCTV & Pipe Grouting Telephone: 414-83 1-5503 Contract Price: $227,000 Completion Date: hne 2023 Class of Work: CCTV & Pipe Cleaning Telephone: 641-421-3682 Contract Price: $588,000 Completion Date: August 2023 Class of Work: CIPP, Grouting & MH Repair Telephone: 414-286-2463 Contract Price: $1,380,000 Completion Date: September 2023 Class of Work: CIPP, Grouting & MH Rehab Telephone: 262-524-3598 Contract Price: $718,000 Completion Date: September 2023 Class of Work: CIPP, Manhole Lining & Grouting Telephone: 616-977 -1000 City of Appleton 100 N Appleton Ave Appleton, WI 54911 Contact: Chad Weyenberg MAJOR PROJECTS COMPLETED IN THE LAST THREE YEARS ConhactPrice: $626,000 Completion Date: December 2023 Class of Work: CIPP Telephone: 920-832-5915 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 07/02/2024 Name Sarah Barber Department Public Works BPW Date 07/09/2024 Phone Extension 9805 Review and Approval Required Prior to Submittal to Board Diversity Compliance and Inclusion Officer Officer Name Cynthia Simmons BPW Attorney Attorney Name Michael Schmidt Dept. Attorney Attorney Name Purchasing Mickey Lovey Check the Appropriate Item Type – Required for All Submissions Professional Services Agreement Contract Proposal Open Market Contract Amendment/Addendum Special Purchase, QPA Bid Opening Bid Award Req. to Advertise Title Sheet Quote Opening Quote Award Reject Bids/Quotes Proposal Opening C/O & PCA No. PCA Chg. Order, No. Traffic Control Resolution Other: Ease./Encroach Required Information Company or Vendor Name New Vendor Yes If Yes, Approved by Purchasing No MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached Yes No Project Name Sewer and Manhole Rehabilitation 2024 Project Number 122-019 Funding Source Sewage Works Capital, Project 299, PR 33672 Account No. 642-509-442003 Amount Terms of Contract Unit Prices Purpose/Description The Division of Engineering requests the Board of Public Works receive and open Public Bids at its Regular Meeting on July 9, 2024, for Project No. 122-019 Sewer and Manhole Rehabilitation 2024. For Change Orders Only Amount of Increase Decrease $ ($ ) Previous Amount $ Current Percent of Change: Increase Decrease % ( %) New Amount $ Total Percent of Change: Increase Decrease % ( %) Time Extension Amount: New Completion Date: